Therapeutic methods using electromagnetic radiation

ABSTRACT

This invention provides methods for treating a variety of disorders using localized electromagnetic radiation directed at excitable tissues, including nerves, muscles and blood vessels. By controlling the wavelength, the wavelength bandpass, pulse duration, intensity, pulse frequency, and/or variations of those characteristics over time, and by selecting sites of exposure to electromagnetic radiation, improvements in the function of different tissues and organs can be provided. By monitoring physiological variables such as muscle tone and activity, temperature gradients, surface electromyography, blood flow and others, the practitioner can optimize a therapeutic regimen suited for the individual patient.

CLAIM OF PRIORITY

This U.S. Utility patent application is a Continuation of U.S. Utilitypatent application Ser. No. 11/486,912, filed Jul. 14, 2006, entitled“Therapeutic Methods Using Electromagnetic Radiation,” which is aContinuation of U.S. Utility patent application Ser. No. 10/180,802,filed Jun. 26, 2002, entitled: “Therapeutic Methods UsingElectromagnetic Radiation,” Constance Haber and Allan Gardiner,Inventors, now U.S. Pat. No. 7,150,710. Issued Dec. 19, 2006, whichclaims priority to U.S. Provisional Patent Application Ser. No.60/301,319, filed Jun. 26, 2001, entitled “Therapeutic Methods UsingElectromagnetic Radiation,” Constance Haber and Allan Gardiner, and U.S.Provisional Patent Application Ser. No. 60/301,376, entitled “MultipleWavelength Illuminator,” filed Jun. 26, 2001, Allan Gardiner andConstance Haber, Inventors.

This U.S. Utility patent application is related to U.S. Utility patentapplication Ser. No. 10/180,643, entitled “Multiple WavelengthIlluminator,” Allan Gardiner and Constance Haber, inventors, filed Jun.26, 2002, now U.S. Pat. No. 6,886,964, issued May 3, 2005 entitled:“Illuminator with Filter Array and Bandwidth Controller.” Each of theabove applications and patents is expressly incorporated herein byreference as if separately so incorporated.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to methods for treating pathophysiologicalconditions using electromagnetic radiation. More particularly, thisinvention relates to applying electromagnetic radiation havingcontrolled wavelengths, bandwidths, pulse durations, pulse frequenciesand/or intensities applied to areas of the body associated with adisorder to treat disorders of the musculature, nerves, blood vesselsand other organs and tissues.

2. Related Art

Electromagnetic radiation is a subject of increasing focus by healthcare practitioners. Sunlight has been described to play an importantrole in health and the prevention of disease. A. Kime, M. D., Sunlight;World Health Publications, Pengrove, Calif., 1980 describes some healthpromoting benefits of exposure to sunlight. The electromagnetic spectrumrelevant to health applications includes short wavelength ultraviolet(“UVA”), midrange and long wavelength ultraviolet (“UVB”), visiblelight, and infrared radiation. Ultraviolet light includes wavelengths ofelectromagnetic radiation of about 0.1 nanometer (nm) to about 380 nm.The ultraviolet spectrum can be considered to have several ranges. UVChas wavelengths in the range of about 0.1 nm to about 290 nm, UVA haswavelengths in the range of about 290 nm to about 320 nm, and UVB haswavelengths in the range of about 380 nm. Visible light is in the rangeof about 380 nm to about 780 nm, and infrared radiation has wavelengthsin the range of about 780 nm to about 1000 micrometers (“μm”).

Lasers and light emitting diodes have been used in acupuncture, painmanagement and tissue regeneration. Lasers produce coherent light, thatis, having radiation waves that are in alignment with each other, andtypically are of a single wavelength. In contrast, sunlight,light-emitting diodes (LEDs) and light from incandescent sources (e.g.,filament light bulbs) produce non-coherent light, that is, radiationwaves that are not in phase with each other. Moreover, non-coherentlight typically comprises more than a single wavelength.

Ultraviolet light has been used to treat skin disorders and to promotethe conversion of Vitamin D to Vitamin D₃, the active form of thevitamin. Flickering red lights have been used to treat premenstrualsyndrome and migraine headaches. Other uses of flickering colored lightinclude treatment of post-traumatic stress disorder. Additionally, skincancer has been treated using a photochemically sensitive cream appliedto the skin and taken up by cancer cells. Subsequent exposure to lighthaving a wavelength of about 630 nm is then provided. The photochemicalis activated within the cancer cells to produce a toxic product thatkills the cells.

Acupuncture is an ancient health care system based on twelve meridianson each side of the body and two master meridians along the center lineof the body. Each meridian contains from about twenty-five (25) to aboutone-hundred fifty (150) acupuncture points. Many health problems areassociated with abnormalities in the meridians. Acupuncture points aretypically stimulated using needles inserted into the meridians, and alsocan be activated by electromagnetic radiation. Electromagnetic radiationhas the advantages of being non-invasive, thus, not contributing to thespread of diseases including human immunodeficiency virus (“HIV”),hepatitis and other blood-borne disorders.

Infrared radiation and low energy lasers are used to treat a variety ofdifferent medical conditions. Photons can be delivered through the skinto underlying tissues, and can be absorbed by the tissue to activatestructures without the potential for causing superficial damage to theskin. Stimulation of certain nerves by non-coherent electromagneticradiation is associated with decreased pain (Haber et al., U.S. Pat. No.6,157,854; PCT/US00/00911). U.S. Pat. No. 6,157,854 describes methodsfor simultaneously exposing acupuncture sites to localized infraredradiation and monitoring temperatures on a contralateral site on thebody.

SUMMARY OF THE INVENTION

Thus, one object of this invention is the development of improvedmethods for treating disorders of the body using electromagneticradiation.

Another object of this invention is the development of improved methodsfor evaluating the efficacy of therapy using electromagnetic radiation.

These and other objects are met by new methods for therapeuticapplication of electromagnetic radiation to tissues that are sensitiveto such radiation. Therapeutic aims include normalization of blood flowto and from, and lymphatic flow from affected regions, and normalizationof muscle tone, nerve activity and other tissue functions. Specificwavelengths can be chosen based on physiologic screening and sensitivitytesting conducted prior to and during the application of treatment.Monitoring of patient's condition can be selected based on the patient'sspecific diagnosis and the organ systems and tissues affected.

Electromagnetic radiation therapy can be carried out by exposing a siteon the body with localized non-coherent radiation of a desired peakwavelength and wavelength bandwidth (herein known as “bandwidth”) whichdoes not vary over time, including those in the infrared, visible,ultraviolet and other portions of the electromagnetic spectrum.Additionally, the wavelength used can vary over time. Fiber optics orother types of waveguides can direct beams of electromagnetic radiationto specific, pre-defined sites on a body with ease. Additionally, withthe advent of devices incorporating dual or multiple illuminationsystems (U.S. Provisional Patent Application titled: “MultipleWavelength Illuminator”, Allan Gardiner et al., inventors, filed Jun.26, 2001, U.S. Utility patent application titled: “Multiple WavelengthIlluminator”, Allan Gardiner et al., inventors, filed concurrently, eachpatent application incorporated herein fully by reference), it is nowpossible to provide, independently controlled beams of electromagneticradiation to specific locations. In other aspects of this invention, aplurality of beams of electromagnetic radiation can be used eithersimultaneously or sequentially, and each having separately controllablewavelength, bandwidth, intensity, pulse duration, pulse frequency, phaseor polarization.

In addition to providing a fixed, narrow bandpass beam, the wavelengthsof electromagnetic radiation can be varied over time during application.For example, in some embodiments, it can be desirable to provide“wavelength variations” around a “central wavelength.” In suchembodiments, a central wavelength can be selected and the illuminatorcan be used to vary the wavelength to include wavelengths of longer orshorter wavelengths, typically in the range of about ±1 nm to about ±100nm, alternatively about ±5 nm to about ±50 nm, in other embodiments inthe range of about ±20 nm to about ±50 nm. It can be appreciated thatother ranges of wavelength variation can be used. It can also beappreciated that one can have variations about a central wavelength thatare asymmetrical, that is, the change in wavelength can be greater inone direction than in the other.

Similarly, the rate of change of wavelength, from the lowest to thehighest can be in the range of about 1 sec to about 100 sec.,alternatively about 5 sec to about 50 sec, in other embodiments in therange of about 20 sec to about 50 sec. Additionally, the rate of changeof wavelength can be in the range of about 1 nm/sec to about 100 nm/sec,alternatively in the range of about 5 nm/sec to about 50 nm/sec, and inother embodiments, from about 20 nm/sec to about 50 nm/sec.

Moreover, the rate of change of wavelength can be varied, and includesby way of example only, linear changes over time, a sinusoidal output,whereby the rate of change of wavelength varies over time according to asine wave function. In other embodiments, the change of wavelength canbe trapezoidal. It can be appreciated that any type of a large number ofvariations in wavelength about a central wavelength can be used.

One or more of a number of methods for selecting and/or varyingwavelength and/or wavelength variation over time can be used. Forexample, prisms, diffraction gratings, rulings, or filters can berelatively inexpensive. Alternatively, diode array emitters can be used.

A portion of a subject's body can be illuminated at locations designedto improve function. Trigger points, acupuncture points,electrodiagnostic points, nerve distributions or blood vessels can beilluminated singly or in combination. Additionally, to improvetransparency of the subject's skin, a small drop of liquid can be used,such as water or oil.

Improved methods for evaluating effects of electromagnetic radiationtherapy include, but are not limited to, the use of sensitive infraredcameras to monitor changes in body surface temperature (“thermography”),surface electromyography (“sEMG” or “SEMG”), oximetry, pulse volume,tissue compliance, monofilament testing, Doppler blood flow, pressurethreshold, current perception threshold, electrodermal activity (“EDA”;a measurement of skin conductance), sweat tests such as the AlizarinSweat Test, somatosensory testing, heart rate variability (includingentrainment), nerve conduction velocity, campimetry, algorimetry, andother methods described herein below and those known in the diagnosticand/or evaluative arts.

To treat peripheral symptoms with electromagnetic therapy, it can bedesirable to expose a nerve innvervating that site close to the exit ofthe nerve from the central nervous system (a “proximal” location). Itcan be desirable to expose a more peripheral part of the nerve (a“distal” location). Alternatively, it can be desirable to expose a nervein an intermediate position between a distal site and a proximal site.Further, it can be desirable to simultaneously expose differentlocations of the same nerve to electromagnetic radiation, and in furtherembodiments, it can be desirable to expose nerves to radiation atdifferent times in different locations.

To treat central nervous system disorders, it can be desirable to modifythe activity of sensory afferent nerves. Alterations in sensory nerveactivity can occur within structures in the spinal cord and/or thebrain, including those structures that are responsible for paintransmission, motor function, or motor control.

Muscle cells and nerves to those muscles can be treated to causerelaxation, thereby decreasing muscle spasms and decreasing symptomsassociated with muscle spasms, such as some types of headaches.

Electromagnetic radiation can be applied simultaneously to the eyesand/or ears or other sensory structures along with peripheral sites. Bystimulating a central nervous system (CNS) site along with a peripheralsite, providing “entrainment” or augmentation of therapeutic effects.Entrainment can be promoted by selecting pulse frequency and phaserelationships between the CNS and peripheral stimuli. In addition to CNSsites, it can be desirable to stimulate a plurality of peripheral sitesto entrain excitable tissues to produce enhanced therapeutic effects.

Although mechanisms underlying the therapeutic advantages of the methodsof this invention are not precisely known, a possible mechanism may bethat electromagnetic therapy can differentially stimulate or inhibitdifferent types of excitable cells within a tissue to produce effects onthose structures. Thus, according to this hypothesis, normalization ofphysiology of muscles, nerves, connective tissues and other tissues canbe achieved by the application of specific electromagnetic radiation totissues responsible for the abnormal function. Specific wavelength,bandwidth, wavelength variability over time, intensity, pulse duration,pulse frequency, polarization of the radiation, and duration oftreatment by electromagnetic radiation can be selected by a physician orother practitioner based upon physiologic screening and by priorhistory.

BRIEF DESCRIPTION OF THE FIGURES

FIGS. 1 a-1 f depict schematic representations of some neuralinteractions.

FIG. 1 a depicts a situation in which a stimulator nerve and aninhibitory nerve act independently of one another to influence a thirdnerve.

FIG. 1 b depicts a situation in which a stimulatory nerve inhibits therelease of transmitter from an inhibitory nerve.

FIG. 1 c depicts a situation in which an inhibitory nerve potentiatesthe release of transmitter from a stimulatory nerve.

FIG. 1 d depicts a situation in which a stimulatory nerve potentiatesthe release of transmitter from an inhibitory nerve, and an inhibitorynerve inhibits the release of transmitter from a stimulatory nerve.

FIG. 1 e depicts a situation in which stimulatory and inhibitory nervesinhibit transmitter release from the other.

FIG. 1 f depicts a situation in which stimulatory and inhibitory nervespotentiate transmitter release from the other.

FIGS. 2 a-2 d each depict a view of a person's head and torso,indicating positions of selected sites of application of electromagneticradiation useful in treating neuromuscular disorders according to thisinvention.

FIGS. 3 a and 3 b depict surface electromyograms (SEMG) of a subjecthaving trapezius spasm. FIG. 3 a depicts the SEMG trace of an affectedside. FIG. 3 b depicts the SEMG trace of a non-affected side of thepatient. The numbers refer to onset of treatment using electromagneticradiation in the visible range of the spectrum, and the + sign refers tocessation of illumination.

FIGS. 4 a-4 b depict SEMG traces of a subject different from that shownin FIGS. 3 a and 3 b having trapezius spasm. FIG. 4 a depicts the SEMGtrace of the affected side. FIG. 4 b depicts the SEMG trace of thenon-affected side.

FIGS. 5 a-5 b depict SEMG traces of a another subject having trapeziusspasm. FIG. 5 a depicts the SEMG trace of the non-affected side. FIG. 5b depicts the SEMG trace of the affected side.

FIGS. 6 a-6 b depict SEMG traces of another subject having trapeziusspasm. FIG. 6 a depicts the SEMG trace of the non-affected side. FIG. 6b depicts the SEMG trace of the affected side.

DETAILED DESCRIPTION

This invention includes methods for treating a variety of physiologicaland pathophysiological conditions using electromagnetic radiation.Electromagnetic radiation can be delivered as a beam of radiation havingdefined wavelength, bandwidth, wavelength variability over time,intensity, pulse duration, pulse frequency, and/or polarization.Evaluation of therapeutic efficacy can be accomplished using severalmethods known in the art. It can be desirable to provide two or moreseparately controlled beams of electromagnetic radiation.

Numerous conditions can be treated using the methods of this invention.Muscular and connective tissue disorders include, by way of exampleonly, sprains, strains, athletic injuries, spasms, fibromyalgia, triggerpoints, myofascial disorders, myalgia, myositis, overuse disorders,weakness from disuse, taut and tender fibers, chronic stresscontractions, muscle spasm, lower extremity neuropathy and muscularrheumatism.

Nervous system disorders include, by way of example only, neuralgia,radiculalgia, radiculopathy, sciatica, carpal and tarsal syndromes,compressive neuropathies, autonomic nervous system disorders, postsurgical pain syndrome, causalgia, RSD, complex regional pain syndrome,post herpetic pain syndrome, chronic pain syndrome, diabetic neuropathyand peripheral neuropathy.

Joint disorders include by way of example only, sprains, strains,degeneration, bursitis, tendonitis, subluxation, segmental dysfunction,articular disorder, postsurgical deformities and post fracturedeformities. Disorders of the skin and integument include, by way ofexample only, lupus vulgaris, acne, eczema, psoriasis. Disorders of theear, nose and throat include, by way of example only, tonsillitis, sorethroat, gingivitis, thrush, and post nasal drip. Disorders of thegenitourinary system includes, by way of example only, hemorrhoids,vulvodynia, pelvic floor ptosis, sphincter atony, urogenital pain andpost-surgical pain. Disorders of the vascular system include, by way ofexample only, peripheral vascular insufficiency, Raynauds's syndrome,varix, and vasospasm.

I Selection of Therapeutic Variables

Electromagnetic radiation therapy can be applied using a range oftherapeutic variables. Variables include the wavelength, bandwidth, theintensity, total radiation dose, pulse duration, pulse frequency,polarization of the radiation, and shape of the beam, among others. Incertain embodiments, it can be desirable to use relatively narrowwavelengths of radiation in the visible spectrum, having a distinct“color.” It can be desirable to vary the bandwidth of wavelengths used,resulting in therapy using a plurality of “colors”. The descriptions ofwavelengths are not limited, however, to visible light, but rather canbe applied to any range of electromagnetic radiation having wavelengthsin the ultraviolet, visible, infrared, or radio frequencies. Thus, incertain embodiments in which the optimum wavelength is not known, it canbe desirable to apply a relatively broad spectrum of radiation around acertain wavelength. As therapy progresses, and the effects of therapyare monitored, one can progressively narrow or broaden the bandwidth ofradiation as desired. Examples of devices for producing electromagneticradiation having different bandwidths are described in U.S. Pat. No.6,886,964 issued May 3, 2005 titled: “Multiple Wavelength Illuminator”,Allan Gardiner et al., inventors, and herein incorporated fully byreference. Although several applications described herein refer tofilter-based illuminators, it is contemplated that other types ofilluminators can be satisfactorily used.

The “bandwidth” of an illuminator is the range of wavelengths ofradiation that are present in an output beam. For example, in afilter-based system, the bandwidth is the range of wavelengths that canpass through a filter or plurality of filters. A bandpass filter has atransmission that is high for a particular band of frequencies and witha lower transmission of frequencies above and below this band. The widthor narrowness of the band for frequencies transmitted through a filteris often measured by the “half bandwidth” that is the full width of theband at half-power or half of the peak transmittance points specified ineither wavelength units or in percent of center wavelength. Anothercommon measure of a bandpass filter is the “half-power point” that isthe wavelength at which a filter is transmitting one-half of its peaktransmission. For example, for a bandpass filter with a peaktransmission of 80 percent, the wavelengths at which it transmits 40percent are the half-power points.

In certain aspects of this invention, illuminators utilize filters thatcan transmit a single wavelength, alternatively a narrow bandwidth, oreven a wider bandwidth radiation. Novel aspects of devices useful forelectromagnetic therapy permit rapid, reproducible control ofcharacteristics of beams of radiation. Illuminators of this inventioninclude sources of electromagnetic radiation (including visibleradiation “light”) that incorporate simple, reliable means for producingbeams of radiation having desired wavelengths and/or othercharacteristics. A source of broad-band electromagnetic radiationproduces radiation having a wide range of wavelengths, including thosedesired. One or more filters placed in the path of the radiation canattenuate certain wavelengths that are not desired, permitting desiredwavelengths to pass through the filter and directed to a target. Thewavelengths of radiation that pass through the attenuator (“filter”)have a characteristic spectrum, depending upon the properties of theattenuator. It can be desirable to rapidly, slowly, and/or controllablychange the wavelength, wavelength bandwidth characteristics, wavelengthvariability over time, polarization, and/or other variables to providepulses of radiation, and to direct beams of radiation to a desired,localized target area. Means are provided to supply radiation, toattenuate radiation, to direct and shape a beam of radiation, andprovide a pulsatile beam having desired pulse duration and frequency tosuit a particular purpose. Systems are provided to coordinate theproduction of one or more beams of radiation and to direct beamsindependently of one another. In some of these embodiments, thecharacteristics of multiple beams of electromagnetic radiation can beregulated separately.

One purpose of filtering to specific narrow bandpass characteristics isto provide radiation that interacts with particular biologic components(e.g. nerve, muscle, blood vessels, blood, connective tissues, etc),specific chemical or molecules, or a wavelength specific receptor. Theability to select both a desired wavelength and bandwidth can permit arapid and efficient means of delivering electromagnetic radiation to anarea or volume of tissue or other material in a reproducible fashion.

Radiation can be used to treat pathophysiological conditions, such asthose caused by diseases or disorders. Physiological responses toelectromagnetic radiation of different frequencies is variable and canresult in different effects. For example, ultraviolet radiation ofwavelengths in the range of about 200 nanometers (“nm”) to 300 nm(ultraviolet wavelengths) can be used for sterilizing wounds or otherphysical objects, and infrared radiation of wavelengths longer than 700nm (or 770 nm, according to some references) may be used to heattissues. Each wavelength of the spectrum from 200 nm to about 1600 nm ormore can be absorbed by tissues differently to provide differenttherapeutic responses. Simultaneous application of two or morewavelengths can be used to augment the response that would have beeneffected by application of a single wavelength. Because of thevariability of each subject (animals and human), the ability to selectspecific wavelengths for that individual is desirable.

A Source of Electromagnetic Radiation

Sources of electromagnetic radiation useful for the methods of thisinvention are not dependent upon any particular source for operation.Each type of source (e.g. tungsten, tungsten-halogen, arc, gasdischarge, broad spectrum light emitting devices “LEDs”, and the like)has a spectral output that may be useful for various therapeuticapplications. Incandescent lamps can provide desirable ranges ofwavelengths, can be found in a variety of configurations, can beinexpensive and readily available. Arc lamps provide radiationcontaining wavelengths from ultraviolet through infrared that can beused as a source for a filter-based system that can deliver a narrowbandwidth, selectable over a wide range of wavelengths in the spectrum.Gas discharge lamps can supply high power pulses. Some lamps, such ascommercial tungsten-halogen reflector lamps and arc lamps can bepre-focused a beam of electromagnetic radiation such that a minimum oflenses are required in the optical path. Reflector lamps can be usefulin situations in which a light-weight, portable device is desired.

B Filter Based Selection of Wavelength and Bandwidth Characteristics

In some embodiments, illuminators include filters for controlling theoutput of electromagnetic radiation. In several embodiments of thisinvention, the means for controlling the output comprises an attenuator,dichroic filter or series of attenuators or dichroic filters. As usedherein, the term “dichroic” means a filter or attenuator that passescertain wavelengths of radiation based upon the wavelength of thatradiation. It can be appreciated that any of the properties of an outputbeam can be controlled and/or selected, either to select a fixedcharacteristic (wavelength, pulse frequency, intensity, wavelengthvariability, and the like) or one that varies as desired over time.

A plurality of filters can be used to adjust the bandwidth of the outputradiation beam. In certain embodiments, a filter assembly comprises aseries of individual filter elements, each having a transmission maximumat a certain wavelength. This wavelength is termed the “peak”,“central”, or “mode” wavelength. Additionally, each filter element has acertain range of wavelengths that can pass through in sufficient amountto be useful for the intended purpose of the illuminator. The group ofwavelengths that can pass through a filter element is termed the“bandwidth” or “wavelength range”. For certain filter elements, thebandwidth can be relatively narrow, that is, the peak wavelength andonly a relatively narrow range of wavelengths on either side of the peakcan pass through in significant amounts. In contrast, for other filterelements, the intrinsic absorptivity of the filter material is such thata relatively wide range of wavelengths can pass through in significantamounts. Such filters are herein termed “wide bandwidth” filters.

Many types of filters are available, and any type of filter material canbe used that is compatible with the types of electromagnetic radiation,the other components of the system, and the ultimate use of theilluminators. For example, plastic, glass, quartz, resin or gel filterscan be provided in sizes that can be adapted for use in a variety ofconfigurations. In certain embodiments, filter elements can be made of abase material and then provided (“doped”) with a material suitable forcontrolling the radiation emitted from the illuminator.

Once manufactured, a plurality of filter elements can be arranged in anarray, in linear or variable relation to each other. For example, aseries of filters can be arranged linearly, to provide a series offilters having progressively increasing (or decreasing) peaktransmission wavelengths. Alternatively, a linear array of filters canbe provided in which certain peak wavelengths are clustered, that is,not necessarily in progressively increasing (or decreasing) peaktransmission. In certain other embodiments, filter elements can bearranged in a circular or ovoid fashion on a rotating disk. Thus, whenthe disk rotates and/or translates relative to a radiation source, thebandwidth characteristics of the radiation can be selected. Alternativeembodiments of this invention utilize a series of fixed filters whichallows selection of spectral transmission based upon the location of thefilter assembly relative to the beam of radiation passing through.Alternatively, a single filter can be manufactured that has bandwidthcharacteristics controlled by way of example, an externally appliedelectrical field.

Regulation of the peak wavelength can be readily accomplished usingdichroic filters. Filters having selected peak wavelength bandpasscharacteristics are known in the art, and can be obtained, for examplefrom Ocean Optics, Inc. Filters can be made using precision lithography,such as used in the semiconductor manufacturing industry.

The “bandwidth” of a filter assembly is the range of frequencies(wavelengths) that pass through a filter. A band pass filter has atransmission that is high for a particular band of frequencies and witha lower transmission of frequencies above and below this band. The widthor narrowness of the band for frequencies transmitted through a filteris often measured by the “half bandwidth” that is the full width of theband at half-power or half of the peak transmittance points specified ineither wavelength units or in percent of center wavelength. Anothercommon measure of a bandwidth filter is the “half-power point” that isthe wavelength at which a filter is transmitting one-half of its peaktransmission. For example, for a bandwidth filter with a peaktransmission of 80 percent, the wavelengths at which it transmits 40percent are the half-power points.

Color is an attribute of visual experience that can be described ashaving quantitatively specifiable dimensions of hue, saturation, andbrightness or lightness. The visual experience also can include otheraspects of perception, including extent (e.g. size, shape, texture, andthe like) and duration (e.g. movement, flicker, pulse duration, and thelike). Color names (e.g. blue, turquoise, etc.) are often used todescribe various wavelengths or groups of wavelengths of visible light.The radiation used in scientific, industrial, and medical instruments isgenerally specified by the wavelengths transmitted and the proportionsof each wavelength within the active area. The use of color names can bea convenient way to express the appearance of the light. For purposes ofthese descriptions, color names can be used to convey an approximaterange of wavelengths used. Color names often describe combinations ofwavelengths of radiation from differing portions of the visiblespectrum. The color to wavelength conversion identity varies slightlyfrom the various resources. One source, Van Nostrand's ScientificEncyclopedia, Third Edition, lists the conversion as:

Violet 390-455 nm Blue 455-492 nm Green 492-577 nm Yellow 577-597 nmOrange 597-622 nm Red 622-770 nmHowever, other reference books recite other wavelength ranges for theabove colors. Thus, we do not intend that each color name be providedwith an exact wavelength or bandwidth characteristic. Rather, each ofthe colors described herein is intended to be a guide for use of thedevices of this invention. For example, for therapeutic purposes, thecolor “violet” may contain amounts of longer, blue wavelengths, and mayalso include certain amounts of shorter wavelengths, in the ultravioletrange. Similarly, the color yellow may contain certain amounts of greenand/or orange light. Moreover, other colors described by their commonnames may include greater or lesser amounts of other wavelengths.

Some commonly named colors include two or more wavelength bands oflight. Magenta, for example, has two peaks, one in the violet region andanother in the red region. Purple has peaks similar in wavelength toMagenta but has higher violet transmission.

Perception of a given color may result from combinations of wavelengthsadded together. The most common combination is red+green+blue. Thesethree colors are used in differing proportions in computer monitors anddisplays to create the colors available on the display. Othercombinations of filters may be used in parallel to produce perceivedcolor. The printing industry adapts to varying ink properties as aroutine matter.

1. Filters

When used for therapeutic purposes, a purpose of filtering radiation tospecific narrow bandwidth characteristics is to provide radiation havingwavelengths that interact with particular biologic components (e.g.nerves, muscles, blood vessels, blood, etc), specific chemicals ormolecules, or other wavelength-specific receptors. Selecting the desiredwavelength(s) and the bandwidths of wavelengths can permit a rapid andefficient means of delivering a reproducible electromagnetic stimulus toan area or volume of tissue or other material.

In certain embodiments, our invention utilizes filters that transmit asingle wavelength (“central wavelength”) or narrow bandwidth ofwavelengths. One aspect of our filter design permits control of thewidth of the bandwidth by means of moving the filter in two directionswith respect to the radiation path. Movement of the filter relative tothe radiation source in one direction controls the peak, center, mean ormode wavelength, and movement in another direction can provide radiationhaving differing bandwidth ranges.

In other embodiments of this invention, a central wavelength can be usedand a time-dependent variation in wavelength around the centralwavelength can be used (“wavelength variation”). By changing themagnitude and/or frequency and/or the rate of change of wavelengtharound the central wavelength, desired therapeutic effects can beelicited.

In certain embodiments, a fixed aperture that limits the transmission ofradiation to a well-defined area such that the mix of wavelengthstransmitted represents the sum of filter elements within that aperture.The amount of radiation at the peak transmission wavelength may diminishas additional filter elements of differing wavelengths are introducedinto the radiation path. This design is simple and can use any desiredaperture area practical.

2. Linear Filter Arrays

In certain embodiments, a series of filters having different fixedtransmission characteristics may be placed between a radiation sourceand one of the waveguides. These filters may be used to select thedesired ranged of wavelengths or to exclude large segments of thespectrum, such as, for example, infrared blocking filters.

In other embodiments of this invention, a linear filter, such as aSchott Veril 60, may be manufactured such that the transmission spectrumcontinuously changes with respect to the position along the filterarray. The variable spectrum characteristics of the filter array areaccessed as desired by moving the filter array along the variablewavelength axis through the radiation beam in the illuminator section bymeans of a mechanism. The mechanism must allow repeatable motion whendriven manually or by a motor. One embodiment of this apparatus uses aleadscrew and carriage assembly to move the filter. Another embodimentuses a rack and pinion type of mechanism. A linear version of thecircular variable filter described below may be manufactured as eitheran array of individual filters or as an array that permits changes inthe width of the spectrum and maximum transmitted wavelength by movingthe filter array in two axes transverse to the radiation beam.

It other embodiments, “wedge” type filters can be used, in which anabsorptive medium is provided on a substrate. One portion of the wedgetypically has a thinner layer of absorptive medium, and another portiontypically has a thicker layer of absorptive medium. An interferencepattern can be generated by wavelengths of radiation, so that radiationemitted can have different wavelengths, depending upon the thickness ofthe layer of absorptive material. Certain filters useful for the devicesof this invention can be obtained commercially from Ocean Optics, Inc.Thus, in certain embodiments, two or more wedge filters can be placednear one another so that the radiation emitted by both filters can becollected and used. However, the above description is not intended to belimiting, rather any available filter types can be used.

In certain embodiments, arrays of small filter elements can be providedthat have small size (about 1 μm on a side) and manufactured usingphotolithographic methods, as used in the semiconductor manufacturingindustry. For radiation having short wavelengths, (e.g., 200 nm), thesize of the filter elements can be even smaller (e.g., 200 nm). Planararrays of such filters can have large numbers of individuallymanufactured filters, and, if desired, each can have different bandpasscharacteristics. Certain of these types of filter arrays can be obtainedfrom Ocean Optics, Inc.

Filters may be fixed in place or moved into or out of the beam bymechanisms provided for that purpose. The characteristics of the filtersare selected for the requirement of the system. For example, a filtermay pass two or more fixed wavelengths of radiation through oneillumination section which is then combined with a variable wavelengthradiation from another illumination section to provide more specificnarrow wavelengths than the number of illumination sections. Additionalfilters may be selected or automatically placed in the radiation path asdesigned into the particular mechanism. Some example of the filter typesare narrow band, cut-off, or bandwidth filters.

Variable filter used to select the wavelength or spectrum of wavelengthsfor each illumination section may be created by a variety of methods andphysical shapes and sizes. The filter media may be of any type that hasthe desired radiation transmission characteristics. Some example filtersinclude gel filters, interference filters, dichroic filters, substratefilters or other types known in the art. The geometry of theillumination beam and the shape and position of filters can be adjustedto obtain radiation having desired spectral characteristics.

3. Circular Filter Arrays

Circular filter arrays can be used that have one or more patterns offilter elements or materials that allow transmission of differentwavelengths depending on the relative rotational position of thecircular filter array and the source beam. The filter array may berotated to discrete angular positions manually or motorized for remotecontrol. A means of repeatedly returning to a desired angular positioncan be provided by a dial or by a memory element associated with themotorizing system. Some examples of a motorizing system are a steppingmotor with a means of initializing the angular position, or, a servomotor with an encoder which provides initializing information.

Dimensions of the beam of radiation relative to the active circumferenceof the illumination section can contribute to the spectral distributionof the radiation entering the waveguide. In some embodiments, a variablefilter pattern can comprise an annulus that has variable wavelengthtransmission along the circumference that passes through theillumination path as the filter is rotated about its axis of rotation.One result can be that each angular position corresponds to a differentspecific narrow spectrum of wavelengths. For filter arrays havingcontinuous and monotonically changing transmission along thecircumference of the array, the width of the radiation spectrum emergingfrom the illumination section is determined by the ratio of the activecircumference to the diameter, or width (for non-circular entranceports) of the beam entering the waveguide. A filter array may also bemanufactured that comprises a series of discrete filter elements ormaterials which are accessed by rotation of the filter disk.

In certain embodiments, a process permits manufacturing of a patternsuch that the transmission characteristics of any angular and radialposition can be selected. The pattern may be such that the area of eachpattern element is small relative to the active area of the beam. Thisallows the center of rotation of the circular filter to be movedrelative to the beam to provide differing transmission characteristicsbased on both active radius and angular position. For example, the outerradius portion of the pattern area may have a constant linearvariability, for example, from 400 nanometers (“nm”) to 1000 nm, thatprovides a narrow spectrum of wavelengths to emerge from theillumination section, while the inner portion of the pattern area mayprovide a mixture of elements that combine to provide a broader spectrumof wavelengths to emerge from the illumination section. Thus moving thecenter of rotation and angle of the filter relative to the radiationbeam can select a specific narrow wavelength or a wider spectrum ofwavelengths. This ability to select center wavelength and spread ofwavelengths allows the system to provide additional control over theradiation emerging from the illumination section.

Illuminators of this invention may have a fixed aperture that limits thetransmission of radiation to a well-defined area such that the mix ofwavelengths represents the sum of filter elements within that aperture.The amount of radiation at the peak transmission wavelength may diminishas additional filter elements of differing wavelengths are introducedinto the radiation path. This design is simple and can use the maximumaperture area practical. In other embodiments, an aperture havingvariable area may be constructed that may increase in size if desired toallow additional radiation of differing wavelengths to be added to theoriginal beam. Conversely, if it is desired to provide a narrower bandpass, the aperture can be decreased in size to exclude undesiredwavelengths from passing. This design can be used to keep the amount ofradiation at peak transmission wavelengths approximately constant whileadding radiation of differing wavelengths.

Selection of peak wavelength, bandwidth and/or intensity can becontrolled by the use of a plurality of shutters positioned relative toa filter array. By opening certain shutters that are positionedcorresponding to a desired peak wavelength, a beam of radiation can becaptured that has that selected peak wavelength. One can open upshutters corresponding to higher, lower, or both higher and lowerwavelengths to permit the passage of radiation having a broaderbandwidth. Alternatively, one can open up a plurality of shutterscorresponding to a peak wavelength to increase the intensity ofradiation in an output beam. A plurality of peak wavelengths can beselected to provide multiple wavelength output beams. It can be readilyappreciated that numerous variations of the above can be used to providea large number of possible output beams.

The types of shutter mechanisms used are not crucial. In certainembodiments, one can use mechanical shutters that can be retracted toopen up an aperture. In other embodiments, an array of mirrors can beused to reflect the beam of radiation toward a particular location. Instill other embodiments, a shutter array can incorporate anelectro-optical device, including by way of example only, liquid crystaldevices (LCDs), Pockels cells, Kerr cells and other optical devices. Ina shutter array, control over individual shutters can be accomplishedusing mechanical or electrical signals, and those can, in certainembodiments, be controlled by a computer program.

C Pulsed Illuminators

In addition to providing radiation having controlled wavelength andbandwidth characteristics, the radiation may be provided in a continuousor pulsed fashion. Pulsing radiation can either provide a frequency ofradiation that can be absorbed by different targets differently toachieve a desired degree of stimulation, or alternatively as a means forcontrolling the total dose of radiation emitted by the device. Toprovide pulses of radiation, any suitable mechanism that can regulatethe pulse width (duration), the frequency, or the pattern of radiationpulses can be used. For example, in several embodiments, radiation canbe passed through a shutter or chopper system to provide theaforementioned radiation as pulses at variable frequencies. In acircular chopper, a disk of opaque material having holes, slits, slots,or areas of transparency can be rotated about an axis perpendicular tothe plane of the disk. A portion of the rotating disk can be placed in abeam of radiation, and during the time that a hole or transparent areais in front of the beam, the beam can pass through the disk, therebyproviding the desired radiation. When an opaque portion of the disk isin front of the beam, the radiation is blocked from passing through.Examples of choppers or interrupters suitable for use with the methodsof this invention are described in the co-pending United States Utilitypatent application titled “Multiple Wavelength Illuminator,” AllanGardiner and Constance Haber, Inventors, filed concurrently,incorporated herein fully by reference. Advantages of pulsed radiationinclude increased efficacy of electromagnetic radiation therapy. Forexample, the use of different frequencies of radiation pulses has beendemonstrated to affect nerve cells differently from muscle cells. Theselection of the wavelength and frequency of the radiation can be basedupon methods developed for each application.

A chopper or shutter mechanism may be placed in the radiation path of anillumination section to provide intermittent pulses. A chopper can bedesirable if it transmits all of the radiation in the open state. Thenumber of apertures in the chopper and the rotational speed of thechopper can determine the pulse rate. Low pulse rates may also beobtained by oscillating the chopper aperture across the radiation beam.The rate that the chopper is moved may be varied over time to produce aprofile of radiation intensity vs. time. A single chopper may be placedsuch that two or more radiation sources pass through the chopper. Theplacement of the radiation sources, the placement of the center ofrotation of the chopper, and the number of apertures affect the relativetiming of the pulses for each radiation source. Certain of theseembodiments can have four apertures and two radiation sources placedsymmetrically around the center of rotation such that the initiation ofeach pulse is concurrent for both entrance ports. Electro-opticalshutters, including by way of example only, LCDs, may be used in placeof the chopper wheel to achieve similar results and add independentinitiation of pulses and/or pulse profiling.

It can be readily appreciated that a chopper or an electro-opticalmechanism can be designed to provide any desired pattern of pulses. Forexample, in one series of embodiments, a circular disk havingtransparent areas arranged in arcs around the disk can be used insituations in which it is desired to have a repeated pattern of pulses.It can be appreciated that the arc length of a transparent area and therotation speed can determine the duration and frequency of pulses.However, by providing transparent areas of differing configurations, forexample, one having a relatively long arc length, and another having arelatively shorter arc length, a pattern of long and short pulses can beprovided. It can also be appreciated that providing transparent areasthat are equidistantly arrayed about the disk can provide a pulsefrequency that is substantially constant. However, by providingtransparent areas of differing distances from one another, one canselect the pattern of radiation pulses.

A pulse can have an abrupt onset or a ramped onset. By providingtransparent areas that have a clean, or “sharp” edge, the onset of apulse can be abrupt. However, by providing a wedge-shaped slot, oralternatively, a gradient transition between opaque and transparentareas, the onset of the pulse can be varied. Moreover, in theseembodiments, one can appreciate that providing a slower rotation canprovide a prolonged transition period between “off” and “on” parts ofthe duty cycle. Although different pulse patterns are described formechanical choppers, it can be readily appreciated that electro-opticalchoppers can be used that can provide a wide variety of pulse patterns.

One or more sensors may be added to monitor the beginning of radiationpulses and functionality of the illumination section. Many devices andmethods are available to determine the start time of a pulse. Forexample, a fiberoptic pickoff may be mounted next to the waveguideentrance port. Output of this pickoff may be used to monitor thewavelength and intensity of the radiation passing through theillumination section when coupled to appropriate sensors. The output maybe passed through a narrow-pass filter to initialize a referenceposition or confirm the positional repeatability of the system. Anotherexample is a sensor to determine the location of the chopper aperturesrelative to the entrance ports. Pulse rate can be adjusted by thechopper motor controller circuitry based on output of an encoderintegral with the chopper motor. The accuracy of the radiation pulserate can depend upon the control circuitry and may have different rangesof acceptable accuracy for different applications.

One series of embodiments of devices include a radiation source, filtersand an optical system to deliver the filtered radiation to a waveguide,such as a fiberoptic element. Multiple radiation sources can be combinedin the fiberoptic cable system and delivered to one or more radiationdelivery ports. The routing of fibers determines the proportion of eachwavelength at each delivery port.

D Multiple Beam Illuminators

Devices of this invention can utilize two or more radiation sources thatmay be of the same or different types. Typical radiation sources includeincandescent lamps, arc lamps, and strobe lamps for systems that areintended to provide selectable wavelengths. Narrow spectrum devices,such as lasers or LED's, may also be used when the bandwidth dispersionis desirably narrow. Gas discharge lamps can have several wavelengthsthat are emitted which may also be useful, such as combining UVradiation with visible and/or infrared radiation.

A radiation source optical system may be as simple as a mirroredreflector behind the radiation source which can focus the radiation beamonto the waveguide. Additional optics may be incorporated as desired forthe particular illumination system. For example, a broad area source,such as a strobe, may use a collecting or collimating lens systembetween the source and the filter. The characteristics of the radiationsource reflector may affect the operation of the system. For example, areflector may be used which allows a high proportion of the infrared(heat) emitted by the radiation source to be transmitted away from thefilter and waveguide.

E Waveguide/Fiber-Optic Cable Assembly

Waveguides or fiberoptic cable assemblies can consist of multiple entryports and one or more exit ports. Routing of the fibers can determinethe proportion of radiation from each entry port to each exit port. Thematerial of the waveguides or optical fibers is selected to permitpassage of the desired wavelengths. For example, glass fibers may beused for visible and infrared radiation (400-1000 nm) while othermaterials, such as quartz fibers may be selected for ultravioletradiation (200-400 nm). Many configurations and materials, includingliquids, are possible. In certain embodiments, there can be two entranceports and two exit ports. The fibers can be routed to provide one-halfof the radiation from each entrance port to be directed to each exitport. This arrangement can provide the user with two radiation sourceswith similar multi-wavelength output.

In other embodiments, alternate fiber routing configurations may be usedto provide different ratios of input to output. For example, a thirdentrance port may have a radiation source that does not utilize a filtersystem. This illumination section may provide output from a simple lampto provide general illumination or may provide a source of ultravioletradiation that can pass directly into the entrance port of the waveguidewith little attenuation.

The output beam of electromagnetic radiation can be provided in a numberof different desired shapes and configurations. For example, for certaintherapeutic uses, it can be desirable to provide beams havingrectangular, triangular, polygonal, circular, oblong, annular, or otherdesired shape. By arranging waveguides in any of the aboveconfigurations, a desired beam can be provided. Randomizing thewaveguides can provide an output beam in which the different wavelengthsand/or bandwidths are distributed randomly within the area of the outputbeam. If desired, a defined array of wavelengths and/or bandwidths canbe provided by maintaining a desired or non-random arrangement offibers. By providing flexible waveguides, different beams can beseparately directed at different desired locations.

F Analysis of Temporal Data and Therapeutic Responses

Analysis of spectral and timing data from illuminators of this inventioncan be performed using a computer and a software package, eitherdesigned specifically for the purpose, or using commercially availablesoftware. A data filter in a commercial application including joint timefrequency analysis using Fast Fourier Transform “FFT” as well as otherdeconvolution methods can permit correlation of spectral and timerelated data (pulse or chop) and physiological effects ofelectromagnetic radiation. In certain embodiments, measurements involvemonitoring a radiation signal using the chopper or electro-opticalshutter to expose a part of a subject's body to radiation of a knownwavelength, bandwidth, pulse width, intensity, and pulse frequency.Simultaneously or at intervals, one can monitor effects of suchradiation using, for example, the surface Electro Myogram (sEMG),electroencephalogram (EEG), evoked responses and the like. An analoginput from a monitoring device and/or from a light source can beprovided into the computer, and the phase and frequency domain of thesignal relative to output of chopper signal can be determined using, forexample LabView™ software. This can be used to determine the signalstrength and the transit time for the signal to travel to the sensor is.The system consists of a chopper, which can be run at a frequency ofabout 1 Hertz (Hz) to about 1000 Hz. In alternative embodiments, thechopper can operate at a frequency of between about 1 Hz and about 500Hz, and in still other embodiments from about 5 Hz to about 100 Hz.Using pulsed illumination, a system can detect the presence of signaland the phase differences between remote locations on the body. This canpermit comparison of transmission capability through excitable tissues,such as nerves, muscles, and connective tissues, in conditions such as,for example, diabetic neuropathy and other nervous disorders, especiallydisorders of the spine. Normal physiological responses can be obtainedby studying subjects without specific disorders, or by studyingunaffected organ and tissues of normal subjects.

Additionally, by comparing the above-obtained normal results with thoseobtained from subjects having specific disorders of excitable tissuesand organs, improved diagnosis of those conditions can be provided.Additionally, by monitoring a subject's responses to electromagneticradiation therapy over time, improved evaluation of the progressionand/or treatment of those disorders can be provided. Additionaldiscussion of specific disorders of excitable tissues is provided in theU.S. Provisional Patent Application titled: “Therapeutic Methods UsingElectromagnetic Radiation,” Constance Haber, D. C., and Allan Gardiner,P. E., inventors, filed Jun. 26, 2001, incorporated herein fully byreference.

G Use of Multiple Beams of Electromagnetic Radiation

One can use different beams of radiation to achieve a desiredtherapeutic aim. In some embodiments, the beams can have the same ordifferent relative intensities, peak wavelength, bandwidth, pulseduration, pulse frequency, and/or polarization. For example, one canexpose a proximal portion of a nerve to radiation having relativelyhigher intensity than a more distal portion, or vice versa.Electromagnetic radiation can be provided continuously, or in shortbursts, termed “pulses”, having known as frequencies or duty cycles.Pulses can be varied according to their frequency and duration. Forcertain uses, it can be desirable to independently vary the pulse rateand duration on each beam. Therefore, it can be advantageous to provideseparate control over each of the above-identified variables, includingcentral frequency, wavelength variation, pattern of wavelengthvariation, pulse duration, intensity, and the like. In certainembodiments, control over the above variables can permit a practitionerto “entrain” different physiological responses, thereby improving theefficacy of therapy.

It can be desirable to expose nerves to localized or “focal” beam ofradiation. In other embodiments, it can be desirable to use beams ofradiation that have different shapes, including, circular, annular,rectangular, triangular, linear and the like. Devices for producing suchvaried beams are disclosed in U.S. Provisional Patent Applicationtitled: “Multiple Wavelength Illuminator”, Allan Gardiner et al.,inventors, filed concurrently, herein incorporated fully by reference.

In certain embodiments of this invention, it can be desirable to treat anerve across or along the nerve distribution by moving the location ofexposure. One can begin at a proximal portion of a nerve distributionand move the site of exposure more distally, or alternatively begin at amore distal site and move the site of exposure more proximally. In otherembodiments, it can be desirable to expose a plurality of sites along anerve distribution. For example, one can expose the proximal most point(spinal exit) of the arm, another site in the intercubital fossa toexpose the median nerve of the arm, and then a more distal site in thehand. If desired, one can progressively move the site of exposurebetween proximal and more distal sites to treat a nerve along a largerportion of its distribution. In other embodiments, it can be desirableto treat multiple sites simultaneously.

The nervous system includes distributions of nerves to each side of thebody. However, nerve distribution to one side of the body can arise fromboth sides of the nervous system. Typically, somatic innervation arisesfrom the opposite, or contralateral, side of the nervous system. Thus,innervation of the left side of the body can arise from the right sideof the brain or spinal cord. Thus, affecting one side of the body canaffect sites on the contralateral side of the body. Additionally,affecting one side can affect sites on the same (“ipsilateral”) side ofthe body. Thus, in certain embodiments, it can be desirable to stimulateeither one side, the other side, or both sides of the body to achieve adesired therapeutic result.

The amount of electromagnetic radiation reaching a tissue can depend onthe wavelength of the radiation, the depth of the site to be affectedand the opacity of overlying tissues to the wavelength used. Thus, toexpose a proximal portion of a nerve, where it exits the spinal column,may require higher absolute intensity than that required to stimulate amore distal portion of the same nerve that is located near the skin.Moreover, electromagnetic radiation having longer wavelengths, ingeneral, can penetrate more deeply into a tissue than can radiationhaving shorter wavelengths. Thus, if the wavelength of radiation used isnot critical, it can be desirable to use longer wavelengths to treatdeeper structures. However, in certain embodiments, it can be desirableto expose deep structures to relatively short wavelengths, and in thesesituations, it can be desirable to use higher intensity radiation toprovide a desired degree of exposure. It can also be desired to vary theintensity of radiation of each of two or more wavelengths to achievedesired therapeutic end points.

II Principles of Activity of Excitable Tissues

Although the mechanisms for therapeutic effects of electromagneticradiation are not known with certainty, one hypothesis is thatelectromagnetic radiation can affect nerves, muscles, or structures thatcan conduct electrical charges, including tendons, ligaments,extracellular fluid and the like. According to an hypothesis asdescribed and applied to nerves, electromagnetic radiation of certainwavelengths may be absorbed by nerves or other nearby tissues, alteringthe activity of the nerve. Depending on the nerve or other type ofexcitable tissue, the type of neurotransmitter used, the types oftransmitter receptors activated, and the wavelength of radiation used,the absorbed energy can either activate or inhibit action of thosetissues. Moreover, mechanisms for activation and inhibition of nervesand muscles by electromagnetic radiation are not known with certainty.According to one theory, when electromagnetic radiation is absorbed, theenergy from that radiation may be manifested by an alteration of one ormore of the fundamental mechanisms that underlie the function of a nerveor nerve cell, a muscle or muscle cell, or other excitable cell ortissue. Because an excitable tissue typically exists within a conductivemedium, such as extracellular fluid, electrical events can be propagatedto sites distant from that tissue. Additionally, the electrical and/orionic state of the medium can affect the responsiveness of an excitabletissue. Thus, according to this hypothesis, electromagnetic radiationcan affect excitable tissues via direct action locally, or via indirectaction on the state of the surrounding tissues and/or medium.

Motor nerves can regulate the functions of effector organs, such asmuscles, exocrine and endocrine secretory cells and the like. Motornerves can arise in the central nervous system in the brain, spinalcord, or peripheral ganglia. Sensory nerves can monitor the states of anorgan, tissue or cell. When activated, sensory nerves can mediate andtransmit sensations of pain, kinesthesia (body position and motion), andcan participate in numerous reflexes, including postural and autonomicreflexes. Symptoms of many disorders include pain as a prominentfeature. Thus, one aim of electromagnetic radiation therapy is in thereduction in pain through alterations in the function of sensory nervesor other structures that can affect sensory nerve function.

Sensory nerves also can assist in control of skeletal muscles. Forexample, within skeletal muscle fibers, smaller specialized musclesexist, known as gamma fibers. Gamma-fibers include a specialized stretchreceptor that is sensitive to the overall length of a gamma fiber. Whenthe gamma fiber is stretched, an associated gamma-sensory neuron cantransmit a signal to the spinal cord, to a primary (or “alpha”) motorneuron innervating that muscle. Increased activity in a sensorygamma-neuron can stimulate the alpha motor neuron to activate themuscle, causing contraction and thus providing a force to counteract thestretch placed on the muscle. This “stretch reflex” is common inpostural muscles, and is a prominent mechanism responsible formaintaining proper muscle tone around a joint such as shoulder,vertebrae or hips, and thereby maintain posture.

The degree of sensitivity of the gamma-loop can be regulated in part bymotor neurons that innervate the gamma muscle fiber (“gamma-motorneurons”). When a gamma-motor neuron is activated, it can causecontraction of the gamma muscle fiber, shortening the gamma fiber anddecreasing the amount of stretch of that fiber and thereby decreasingthe stimulation of the gamma sensory fiber. Thus, when the gamma musclefiber is short, the gamma reflex mechanism is relatively insensitive tostretch, and when the gamma fiber is relaxed and the gamma-sensoryneuron is relatively stretched, the reflex mechanism is relativelysensitive to further stretch. Thus, the gamma fiber, the gamma stretchreceptor, and the gamma motor neuron comprise a “gamma loop” that aidsin maintaining posture through the stretch reflex.

Alterations in the relationships between gamma-loops and the skeletalmuscle in which they exist can lead to abnormalities of posture, and topain. According to one hypothesis, an imbalance between the gamma-loopsand the normal, voluntary control of skeletal muscle can lead to musclespasm, pain, and other symptoms.

Sensory and motor nerves can interact with each other through lessspecific interactions, involving additional levels of neuralintegration, through brain structures such as the hypothalamus,thalamus, reticular activating formation, cerebrum and others.

Thus, in certain embodiments of this invention, one goal of therapy withelectromagnetic radiation is restoration of normal physiological balancebetween different aspects of the nervous system and the musculature. Thedescription that follows is intended to illustrate some of theprinciples of physiology of excitable tissues, using nerves as anexample. The descriptions are not intended to be comprehensive. Furtherdiscussions of the physiology of nerves and the chemical transmittersthat are involved in neurotransmission can be found in Goodman andGilman's The Pharmacological Basis of Therapeutics, Ninth Edition,McGraw Hill, 1996, incorporated herein fully by reference.

A Neuronal Physiology

Physiological mechanisms that underlie neuronal function have beensubject of numerous studies for many years. Neuronal function can bealtered by affecting the concentrations of ions inside and outsidecells, the conductance of the nerve to those ions, the release ofneurotransmitters, the sensitivities of neurons to those transmitters,or other factors. Typically, at rest, nerve cells (“neurons”) and musclecells (“myocytes”) can have a net negative charge in their interiors,relative to the outside, or “extracellular” milieu. Neurons typicallyhave positive charges in the form of positively charged potassium (“K+”)ions and negative chloride (“Cl⁻”) within the cell. In contrast, theextracellular milieu comprises a positively charged sodium (“Na⁺”) ionsand negatively charged Cl⁻ ions. The concentration of K⁺ ions in theextracellular space typically is lower than that in the intracellularmilieu, and Na⁺ ion concentrations within neurons is typically lowerthan that in the outside milieu. Thus, there is a concentration gradientfor Na⁺ from the outside of the cell to the inside, which, if themembrane were permeable to Na+ ions, would result in the flow of Na⁺into the cell. Similarly, there is a concentration gradient for K⁺ ions,from the inside of the cell to the outside, which if the membrane werepermeable to K⁺ ions, would result in the flow of K⁺ ions outside thecell. Under resting conditions, however, the permeability of neuronalcell membranes to K⁺ ions is not the same as the permeability of theneuronal membrane to Na⁺. Rather, on average, K⁺ leaves the cell moreeasily than Na⁺ enters the cell, resulting in a net decrease inintracellular positive charges. This results in a negative or “restingpotential” or voltage difference from the inside of a cell to theoutside of the cell. Cells that typically can have negative restingpotentials include neurons, muscle cells and many glandular cells. Thisresting state is termed “polarization.”

Activation of nerves, muscles, and in some cases, glandular cells, canresult from an alteration in the flow of ions across the cell membrane.For example, mechanical stimulation of most nerves can produce anincreased (less negative) intracellular potential. This process istermed “depolarization.” If the increase in potential is sufficientlylarge, the membrane potential can reach a “threshold” voltage, at whichNa+ ion channels can open, permitting Na+ ions to flow into the cell,further increasing the intracellular voltage. In nerves and musclecells, this process is termed an “action potential.” Action potentialsare important mechanisms for nerve transmission (“neurotransmission”).Similarly, in many types of muscle cells, including cardiac and skeletalmuscles, action potentials can produce changes in calcium (“Ca+”) ionmovements and activation of the muscle fibers, causing contraction.

It can be appreciated that changing the ionic composition of theextracellular milieu can alter the gradients of ions across a cellularmembrane. Thus, by increasing the concentration of Na+ ions in theextracellular milieu, the gradient for Na+ can increase. Then, if Na+channels open, more Na+ is available to enter the cell, therebyincreasing the amount of positively charged ions within the cell.Similarly, alterations in concentrations of other ions in theextracellular milieu can alter the movement of those ions into and/orout if cells. According to this hypothesis, because most parts of thebody are in electrical contact with each other, via electricallyconducting fluids containing ions, alteration in the electrical and/orionic state of one tissue can affect the electrical and/or ionic stateof another tissue. Thus, electromagnetic radiation can have numerouseffects on excitable tissues at the site(s) of absorption of theradiation, and at sites remote from the site(s) of absorption.

B Synapses and Neurotransmitters

Activation of a nerve or muscle can be initiated by the secretion ofspecific chemicals, herein termed “neurotransmitters” between neurons orbetween a neuron and a muscle cell. One type of junction between nervecells is termed a “synapse” and a corresponding type of junction betweena nerve and a muscle cells is termed a “neuromuscular junction.”Conduction of electrical activity between cells across synapses orneuromuscular junctions can be accomplished by the secretion of one ormore neurotransmitters by one cell and the attachment of thoseneurotransmitters onto specific receptors within the membrane of theneighboring cell. Binding of neurotransmitter can either causedepolarization of a cell membrane, or alternatively can further polarizethe cell membrane. Depolarizing neurotransmitters include acetylcholine,(“Ach”) which is a widely distributed transmitter in cholinergic nerves.Many neurons are sensitive to the neurotransmitter acetylcholine(“Ach”), which is responsible for many neurophysiological phenomena,including contraction of voluntary muscles and many central nervousfunctions, including ganglionic transmission and cerebral transmission.

Other nerve types include the adrenergic nerves, which can useepinephrine (adrenalin, “EPI”), nor-epinephrine (“NE”), serotonin,dopamine (“DA”) and a number of other chemical transmitters known in theart. Depending on the nerve location, the transmitter and the types ofreceptors involved, a nerve may be either unaffected, polarized ordepolarized. By way of illustration, a resting or polarized nerve willrequire a certain degree of depolarization to become activated toproduce an action potential. If a neurotransmitter further polarizes thenerve, resulting in a “hyperpolarized” state, it may require more of thedepolarizing neurotransmitter to cause an action potential in thatnerve. Conversely, if a second type of depolarizing transmitter ispresent, then a smaller amount of the first depolarizing transmitter isneeded to cause the nerve to exhibit an action potential. Thus,inhibition of nerve action can be by way of hyperpolarization, whereasheightened nervous sensitivity can be caused either by increased “tone”of the transmitter system normally involved in depolarizing the nerve,or by increased release of a different, depolarizing neurotransmitter.These opposing effects of polarization and depolarization are importantmechanisms involved in maintenance of normal function, or “homeostasis.”

C Autonomic Nervous Systems

Many bodily functions are modulated by branches of the nervous systemknown as the “autonomic” nervous systems. Autonomic nervous systems canregulate gastrointestinal function, blood pressure, blood flow, bodytemperature control, and numerous other processes. Autonomic nervoussystems can be present in an organ or tissue as two (or more) systemsoperating independently, cooperatively or in opposition to one another.For example, in the gastrointestinal tract, the cholinergic autonomicnervous system (generally, the “parasympathetic” nervous system) canstimulate gastrointestinal smooth muscles through the release ofacetylcholine, which in those tissues, can act on a type of cholinergicreceptor known as “muscarinic receptors.” Stimulation of muscarinicreceptors can lead to decreased heart rate, increased gastrointestinalmotility, and other effects. In contrast, acetylcholine acting throughanother type of cholinergic receptor, the “nicotinic receptors” isinvolved in autonomic ganglion neurotransmission.

Another branch of the autonomic nervous system is the “sympathetic”nervous system. In the gastrointestinal tract, the sympathetic nervoussystem can inhibit the smooth muscle contraction caused by activation ofparasympathetic nerves. Sympathetic nerves characteristically usechemicals known as catecholamines or other monoamines asneurotransmitters. Well-known catecholamines include epinephrine andnorepinephrine. Epinephrine and norepinephrine can act on specificadrenergic receptor types, termed “alpha-adrenergic” and“beta-adrenergic” receptors. Activation of alpha-adrenergic receptorsstimulates contraction of vascular smooth muscle, causing blood vesselnarrowing and leading to increased blood pressure and/or decreased bloodflow through that vessel. In contrast, activation of beta-adrenergicreceptors can lead to relaxation of blood vessel smooth muscle, which,in turn can lead to decreased blood pressure and/or increased bloodflow. Activation of beta-adrenergic receptors in the heart can increasepulse rate and force of cardiac contraction, effects which can lead toincreased blood flow.

Norepinephrine can cause contraction of blood vessel smooth muscle,resulting in decrease in blood vessel diameter. In arteries, decreasedvessel diameter can lead to increased blood pressure, decreased bloodflow, or both. In veins, blood vessel contraction can lead to increasedcardiac input, which can result in increased cardiac output andincreased systemic blood flow. In contrast, acetylcholine acting viamuscarinic receptors, can relax blood vessel smooth muscle cells, andcan result in decreased blood pressure and/or increased blood flow.Activation of muscarinic receptors in the sino-atrial node of the heartcan lead to decreased heart rate. Thus, the adrenergic and cholinergicsystems (sympathetic and parasympathetic) can, in certain situations,tend to counteract one another, leading to opposing influences on endorgans innervated by both types of neurons.

D Neurotransmitter Receptors

Within the same branch of the autonomic nervous system, differentreceptors and transmitters can exert competing or opposing effects. Forexample, norepinephrine, an adrenergic transmitter, is a potentstimulator of the adrenergic receptor type known as “alpha-adrenergic”receptors. In contrast, norepinephrine is a relatively weak stimulatorof “beta-adrenergic” receptors. Unlike norepinephrine, epinephrine (alsoknown as adrenalin), at low concentrations, is a more potent stimulatorof beta-adrenergic receptors than it is of alpha-adrenergic receptors.Thus, epinephrine in low concentrations can cause vasodilation, candecrease blood pressure, and can increase blood flow. At highconcentrations, epinephrine's effects on alpha-adrenergic receptors candominate over the effects on beta-adrenergic receptors, and can causeincreased blood vessel contraction and can lead to increased bloodpressure.

E Peptidergic Innervation

In addition to the cholinergic and adrenergic systems, other types ofnerves use peptides or amino acids as neurotransmitters. A examples of apeptide transmitter is substance P, (“SP”) a member of the “tachykinin”family of peptides. SP is a transmitter of painful stimuli, and is oneof the chemicals released by the active agent of red peppers, capsaicin.Other tachykinins include neurokinins A and B. Other types ofpeptidergic nerves use enkephalins, endorphins, vasoactive intestinalpeptide (“VIP”) somatostatin, calcitonin gene-related peptide, gastrinreleasing peptide, and numerous other peptides known in the art. As withthe sympathetic and parasympathetic nervous systems, peptide-containingnerves may have opposing or synergistic actions with those of otherpeptidergic nerves or with sympathetic and/or parasympathetic nerves.

In the spinal cord, painful transmission is thought to be mediated bysensory afferent nerves that use substance P (SP) as a neurotransmitter.In certain locations within the spinal cord, other nerves, using opioidssuch as enkephalins and/or endorphins, can interact with the afferentpain nerves. Enkephalins can decrease the activity of sensory painnerves, and therefore, represents one physiological mechanism forreduction in pain, (also termed analgesia).

F Somatic Innervation

In addition to autonomic nerves, “somatic” nervous system is responsiblefor such effects as voluntary control of skeletal muscle. Somaticinnervation typically can be present in a segmental pattern, that iseach portion of the body is innervated by nerves arising from a discreteportion of the spinal column, usually associated with differentvertebra. Thus, control of upper portions of the body are typically byway of spinal nerves exiting the vertebral column in high vertebrae,such as neck (“cervical”) or chest (“thoracic”) vertebrae. Lowerportions of the body, such as the legs are typically innervated bynerves exiting the spinal column in lower thoracic, lumbar or sacralareas.

One common source of arm, back or leg pain can be due to mechanicalcompression of the spinal sensory nerves. For example, if a lower spinalnerve is exposed to pressure, that pressure can be sensed as pain, forexample, in sciatica. Another source of disorders can be pressureexerted on motor (also known as “efferent”) nerves. Compression ofsympathetic efferent nerves can lead to disorders of blood flow.Compression of somatic nerves can lead to weakness or even paralysis.

G Activation of Nerves

Nerves can typically be activated by mechanical or chemical stimuli.Even nerves that act primarily as chemical sensors (“chemoreceptors”)can be activated by mechanical stimulation, such as pressure. Activationof nerves under normal physiological situations typically can involvethe stimulation of areas of the nerve termed “dendrites”. When sostimulated, an alteration in a neuron's resting potential can occur,resulting in depolarization. When depolarization becomes sufficientlylarge, a certain voltage threshold can be reached and an “actionpotential” can be initiated, either within the dendrites, in theneuronal cell body (also known as the “soma”) or in an axon. An actionpotential can be propagated along an “axon” which in motor nerves tovoluntary muscles, can be 1 meter or more in length. Thus, activity of aneuron in one location can be reflected in activity at remote locationswithin the distribution of that nerve. Typically, a single chemicalstimulus, such as that caused by a single neurotransmitter molecule, isinsufficient to cause an action potential. Rather, it may be necessaryfor a number of receptors to be stimulated to cause sufficientdepolarization to produce an action potential.

It can also be appreciated that many portions of a nerve cell canrespond to depolarization. For example, mechanical or electricalstimulation of an axon can result in an action potential beingpropagated in both directions along the axon, one direction towards thesoma and another toward the distal portions of the neuron. In situationsin which an action potential initiated in an axon invades a soma, theelectrophysiological state of the soma can be changed. If a soma becomesdepolarized, less dendritic stimulus may be required to initiate anaction potential, and the nerve can be stimulated relatively moreeasily. Conversely, if the soma becomes hyperpolarized, then it canbecome less sensitive to stimulation and can be inhibited.

Once an action potential has occurred, many neurons become unable togenerate an action potential for a period thereafter (“refractoryperiod”). During the refractory period, the nerve may not respond tostimulation.

The multiplicity of nerve types, neurotransmitter types, and receptortypes and the differing effects of activating those receptors can haveimplications in health and disease. Thus, unbalanced or unopposed actionby any of the above-described nerve, neurotransmitter, or receptor typesmay lead to specific disorders. For example, causes of migraineheadaches include unopposed vasodilation of certain blood vessels whichcan lead to increased pressure on sensitive nerves, leading to painfulsensations. Conversely, unopposed vasoconstriction can lead to decreasedperfusion, local acidosis, and pain associated with acidosis. If thevasoconstriction is sufficiently sever, loss of tissue function canoccur. In certain cases, decreased perfusion of a portion of the centralnervous system can lead to strokes or other dysfunctions.

Many tissues and organs can be influenced by multiple nerve typesdescribed above. Thus, certain tissues, such as voluntary muscle canhave somatic nerves that innervate muscle fibers, and the blood vesselswithin the muscle can be influenced by autonomic sensory and/or motornerves. Thus, an organ or tissue can be influenced by multiple types ofnerves, neurotransmitters, and transmitter receptors. In certainsituations, different nerves, transmitters, and/or receptors cancounteract the effects of others, resulting in inhibition of nervousfunction, whereas in other situations, one mechanism can increase thefunction of another, resulting in activation. Therefore, improperbalance between different inhibitory and stimulatory mechanisms, can,according to one hypothesis, lead to symptoms and disease.

H Nerve-Nerve Interaction

In addition to nerves having different effects on end organs, differentnerves can have influences on each other. By way of illustration, FIGS.1 a-1 d depict two different nerves, called “A” and “B”, impinge onanother nerve (“C”). In FIG. 1 a, nerves A and B each affect nerve C.Nerve A releases a transmitter that stimulates (+) nerve C, and nerve Breleases a transmitter that inhibits (−) nerve C. Activation of nerve Aby itself, can lead to activation of nerve C. Activation of nerve B byitself does not activate nerve C. However, stimulation of nerves A and Btogether may result in either activation or no activation, depending onthe relative efficacy of nerves A and B on nerve C.

FIG. 1 b depicts a situation in which the neurotransmitter for nerve Acan stimulate nerve C and can inhibit the release of transmitter fromnerve B. In this situation, activation of nerves A and B can result inactivation of nerve C. FIG. 1 c depicts a situation in which thetransmitter of nerve B stimulates the release of transmitter from nerveA. Thus, activation of nerves A and B together can result in more of thetransmitter being released from nerve A than can be released in responseto stimulation of nerve A alone. FIG. 1 d depicts a situation in whichnerve A stimulates release of transmitter from nerve B, and nerve Binhibits release of transmitter from nerve A. Activation of nerve Apromotes the release of transmitter from nerve B, which inhibitstransmitter release from nerve A. Thus, activation of both nerves A andB will result in a predominant effect of nerve B, because release oftransmitter from nerve A will be inhibited. The net effect will be aninhibition of nerve C.

FIG. 1 e depicts a situation in which nerves A and B each inhibittransmitter release from the other. If nerve A is activated, it willinhibit the actions of nerve B, and if nerve B is activated, it willinhibit the actions of nerve A. If one nerve is activated more than theother, that effect on nerve C will be more pronounced. Simultaneousactivation of both nerves A and B will result in an outcome that dependsupon the relative potencies of effects of transmitters on the nerves andon nerve C. This type of mutual inhibition typically characterizesmechanisms that promote steady-states and relatively low amounts oftransmitters being released.

For example, under certain situations, acetylcholine can act onadrenergic nerves to decrease the release of adrenergicneurotransmitters such as norepinephrine. Conversely, under certaincircumstances, norepinephrine released by adrenergic nerves can decreasethe release of acetylcholine from cholinergic nerves. If there is a highlevel of activation of, for example, the adrenergic systems, thenincreasing the level of cholinergic activity may tend to decrease theeffects of the adrenergic stimulation. Similarly, if there is a highlevel of activation of the cholinergic systems, increasing adrenergicactivity may decrease the effects of the cholinergic stimulation.

FIG. 1 f depicts a situation in which the neurotransmitters of bothnerves A and B increase the release of another transmitter from theother nerve. In these situations, the effect on nerve C will bedifficult to predict, as the effect will depend on the magnitudes of theinteraction and on the effects of each transmitter on nerve C. Moreover,relationships such as these can also result in the depletion oftransmitters from nerves A and B, decreasing their ability to respond tostimuli.

These types of nerve-nerve (or “neural”) interactions can occur at thelevel of the end organ, at the ganglion level, at the spinal cord level,at the medullary level, or any other location at which different typesof nerves can interact with each other. Abnormal potentiation and/orinhibition of one or more of these levels of the nervous system can leadto disorders. Although the exact mechanisms may be difficult to predictin advance, the methods of this invention can permit a phenomenologicalapproach to therapy, the efficacy of which can be evaluated separatelyfrom any particular mechanism of action. By focusing on physiologicalresponses of treated organisms, organs, tissues and cells, thepractitioner can determine the optimum therapeutic approach and canachieve desirable results, regardless of the exact mechanisms of actionof electromagnetic radiation.

III Therapeutic Goals

Thus, a therapeutic goal of certain methods of this invention is therestoration of proper “balance” between different regulatory mechanismsresponsible for the disorder. Accordingly, one hypothesis to account forthe beneficial effects of the methods of this invention is that byreturning proper balance between the different branches of the autonomicor somatic nervous systems and the tissues innervated, adverse symptomscan be alleviated. For example, in adrenergic or sympatheticoveractivity, reducing the activity or “tone” of the sympathetic nervescan be beneficial. Similarly, in systems in which both parasympatheticand sympathetic innervation is important, sympathetic overactivity canbe treated by either decreasing sympathetic tone or by increasingcholinergic tone. In systems in which adrenergic, cholinergic,peptidergic, serotonergic, dopaminergic, and other nervous mechanismsare present, complex interactions between the different mechanisms canbe a delicate balance, a balance that can be easily upset, causingdisorders. Thus, according to this hypothesis, one therapeutic aim ofthe methods of the present invention is the return of the variousbranches of the nervous system to balance.

According to another hypothesis, abnormalities in vascular perfusion canlead to disorders and symptoms. For those conditions, vascularhyperperfusion can lead to increased temperature, and hypoperfusion canlead to decreased temperature. Thus, in those conditions, a therapeuticaim is the normalization of blood flow. For disorders characterized byhyperperfusion, therapeutic aims include decreasing blood flow, and fordisorders characterized by hypoperfusion, therapeutic aims includeincreasing blood flow.

The above hypotheses represent only possible mechanisms of action of themethods of this invention. Other mechanisms may be responsible for thebeneficial effects of electromagnetic radiation therapy, and we do notintend to limit the scope of this invention to any particular theory ortheories of operability.

Evaluation of the efficacy of therapy with electromagnetic radiation mayinvolve impressions of the patient, including the degree of the symptomexperienced, or may be evaluated using one or more of a variety ofmethods described below.

IV Methods for Treating Specific Disorders

To treat disorders using the methods of this invention, one can varywavelength, bandpass, duration, intensity, pulse frequency, ortime-dependent changes one or more of these variables to achievebeneficial results. One beneficial purpose of using variations of theabove characteristics over time is to accommodate differences inindividual subjects' responses to different stimuli. Thus, in asituation in which a subject does not respond to “pure” light having afixed characteristic, the use of variable characteristics can provide adesirable level of activation or inhibition of the affected portion ofthe subject's body, thereby increasing the efficacy of treatment andincreasing the numbers of subjects that can benefit from treatment.

Headaches and Stroke

Certain aspects of this invention involve treating disorders of thenervous system. In certain embodiments, patients suffering fromheadaches or strokes can be treated by exposing the occipital nerve. Theoccipital nerve exits the base of the skull at the cervical-1 (“C-1”)location. Stimulation is desirably near a midpoint between the spinousprocess and the mastoid region. This region may be identical to theacupuncture point GB 20. This area is usually tender to palpation, ascan be the area of the frontalis muscle. Hyperactivity of the frontalismuscle can be a significant cause of headaches. Treatment of the GB 20region can be especially useful of GB 20 or the frontalis muscle isunusually tender to palpation.

Efficacy of treatment can be assessed by surface electromyography(“sEMG”), which monitors the electrical activity of the structures(e.g., muscles and nerves) beneath the skin at that location. Infrontalis muscle hyperactivity, the increased muscular contractions canbe detected as increased frequency and amplitude of electricalpotentials monitored over those locations.

In many patients, application of pressure to GB 20 can produce painradiating from the sub-occipital region, in the transverse hemicraniuspathway, over the top of the head, and terminating at the inner canthusof the eye, typically at or below the level of the eyebrow. A portion ofthe nerve exits the scull at that location from a small fossa that canbe identified by palpation. Thus, electromagnetic radiation therapy ofthat point, using any wavelength between about 200 nm and about 1600 nmcan be useful, as well as at GB 20 can decrease the muscle hyperactivitythat causes the headache pain. Radiation in the orange range of thevisible spectrum can be used at the start of therapy. Alternatively,yellow radiation can be used. In certain embodiments, mixtures of orangeand yellow light can provide improved therapeutic efficacy. However,other wavelength ranges can also be beneficial, including those in theinfrared range.

In certain of these embodiments, it can be desirable to provideelectromagnetic radiation at a specific angle relative to the patient'shead. By applying the beam of radiation at an angle of about 45°cephalad, the total time required to treat symptoms can be substantiallydecreased. Applying electromagnetic radiation at both sites for aduration of about one (1) minute can result in improvement in symptoms,including increased muscle relaxation, increased sense of being at easeand reduction in pain. Additionally, in untreated patients, palpation ofthe temporal artery can result in significant discomfort, and withtreatment, the sensitivity of the temporalis artery can be significantlydecreased.

In certain embodiments, it can be desirable to use two separated,distinct frequencies within the electromagnetic spectrum. In theseembodiments, one may expose a proximal portion of a nerve and a distalportion of the same nerve to radiation of different wavelengths. In someembodiments, it can be desirable to vary the wavelength of theelectromagnetic radiation during therapy. Thus, one can initiate therapyusing radiation of one wavelength, and then progressively alter thewavelength. For example, in situations in which “relaxation” of a nerveis desired, one can use radiation in the orange. As therapy progresses,one can shift the wavelength to shorter wavelengths, such as yellow,which can provide a “stimulation” of the nerve. Alternatively, one canuse multiple wavelengths simultaneously, with the ratio of each beingselected. For example, one can use orange:yellow wavelengths in a ratioof about 30:40, to achieve a desired balance between “relaxation” and“stimulation” of the nerve. However, it can be appreciated that otherratios of colors may be useful.

Inhibition of Hyperactive Nerves: Neuronal Pain

In situations in which nerve “hyperactivity” is a source of symptoms, itcan be desirable to expose that nerve to electromagnetic radiationhaving wavelengths in the blue region of the visible spectrum.Additionally, it can be desirable to provide pulse rates in a range ofabout 1 Hertz (Hz) to about 1000 Hz. In addition, in certainembodiments, it can be desirable to expose the nerves on thecontralateral side of the body. It can be desirable to stimulate thesite of pain, or more proximally along the distribution of the nerve, oralternatively, more distally.

In situations in which the pain is not responsive to localizedtreatment, it can be desirable to apply radiation at the coccyx, thelower end of the spinal column, and another beam of radiation to the topof the spinal column, for example at or near C1. In some patients withthis type of disorder, thermography can show a region of elevatedtemperatures, termed a “hyperthermic stripe” along the axis of thespinal column. Exposing the two ends of the spinal column toelectromagnetic radiation can result in decreased temperature of thehyperthermic stripe and can decrease the pain. It can also be desirableto apply therapy using small, discrete locations, with narrow beamradiation to treat nerves. Alternatively, to treat muscles, it can bedesirable to use radiation having wider dimensions to treat a wider areaof the muscle.

Treatment of Myofascial Syndrome

Myofascial syndrome is characterized by specific areas of theirmusculoskeletal system that are particularly painful. Many cases ofmyofascial syndrome arise from whiplash, automobile injuries, falls,skiing accidents, stress trauma, and repetitive stress injuries. In manypatients having myofascial syndrome, usual allopathic prescriptives,including ibuprofin and muscle relaxants have been unsuccessful atalleviating symptoms. In some patients, antidepressants have also beenfound to be unsatisfactory. Physical therapy including massage andstretching have also been found to be unsatisfactory. In some cases,electrical stimulation therapy has been used, and in some cases, foundto be unsatisfactory. Additionally, exercise rehabilitation can makesymptoms worse.

One hypothesis to account for myofascial syndrome includes musclehyperactivity. With repeated use, the muscles become contracted andpainful. Limited motion can place additional stress on the tightenedmusculature and the spinal column, and pain can be found between theshoulder blades (scapulae), neck, radiating from the head, or pain inthe lower back.

Physical examination can reveal taught musculature, either focally orregionally, and deep palpation results in tenderness. Some of thesepatients have limited range of voluntary motion, but passive motion isunhindered. Typically, these patients have no geigenhaulten patterningand no end point rigidities.

Thermal imaging reveals elevated temperatures in specific regionslocated above or near a trigger point. In the upper body area, such asthe upper back, these points can be located at the mid portion of theupper trapezius, the levator scapula and the rhomboid grouping. In somepatients, the hyperthermia is unilateral, but in certain of these cases,the upper trapezius on the right and the levator scapula on the leftwill be involved.

Therapy for these patients is generally to expose the affected musclesto electromagnetic radiation beginning at the muscle's origins and thenprogressing to the muscle's insertions. The specific sites to be treatedare identified by palpitation, with the trigger points being those mostsensitive to palpation and result in referred pain.

The wavelengths of radiation include orange first to alleviate the pain.Next, radiation in the blue range is useful, and in certaincircumstances, purple radiation is desirable. Radiation in the shortervisible range (blue and purple) can result in cooling an area. In painassociated with hyperthermia, cooling can be associated with reductionin pain.

Example 1 Treatment of a Patient Having Myofascial Syndrome and RightLower Extremity Pain

A patient presented for treatment with a history of right sided, lowerextremity pain. Previously, the patient had visited 16 physicians andhad undergone a surgical procedure in her neck in an attempt toalleviate the pain. The pain was focused on the right iliac crest regionand at the intersection between the buttock and the hamstring musclegrouping. The pain radiated in a course more laterally and then downalong the leg, transecting the knee and down the anterior aspect of theleg to the dorsum of the foot. The patient kept her right foot inexternal rotation. She also had right iliac crest elevation. Her gaithad a lateral lurch, in which she shifted her weight to her left leg andattempted to elevate her right leg rather than allow it to move directlyforward.

Thermography indicated a large area (about 4 inches in diameter) ofhyperthermia located over the right gluteus medius and minimusmusculature. Upon palpation with light digital compression resulted inimmediate replication of the pain symptom complex. A diagnosis was madeof myofasciatis with a trigger point with a zone of referred pain.

Application of electromagnetic radiation in the infrared wavelengthrange resulted in substantial alleviation of pain and her gait becamenormal. With three additional treatments, one per day, the patient wasdischarged in an asymptomatic state.

Treatment of Sympathetic Hyperactivity

Certain patients present with easily fatigued muscles. In certain ofthese patients, one underlying cause can be associated withhyperactivity of the sympathetic nerves innervating the blood vessels inthe muscle. If the sympathetic nerves are hyperactive, the blood vesselscan be in a state of heightened contraction, resulting in decreasedperfusion of the muscle. With decreased perfusion, there can be alowered supply of nutrients and oxygen, and a concomitant increase inlacetic acid and carbon dioxide in the muscle, leading to acidosis.These conditions can contribute to muscle fatigue. Upon exertion, thepatient can experience a burning sensation, which, in time can lead todysfunction.

Thermography of these areas typically can show areas of lowertemperature, in contrast to the areas of hyperthermia associated withmyofascial syndrome. Electromagnetic radiation therapy of the musclescan lead to further decreases in observed temperature, and may notrelieve symptoms.

In these patients, it can be desirable to treat the blood vesselsleading to the muscle, and not to directly treat the muscle. Thus, oneapproach to treat lower extremity sympathetic hyperactivity is to exposethe abdominal aorta to electromagnetic radiation. In general, thesympathetic innervation of a peripheral blood vessel, such as a legartery, follows the path of the blood vessel to that site. Thus, becausethe arteries of the legs arise from the abdominal aorta, exposing theabdominal aorta to radiation can affect more peripheral sites along theblood vessel's distribution, in a fashion in some ways similar to thatof the affects of exposing proximal nerves can affect more distalportions of the nerve.

One method of treating such patients is to expose an area of theabdominal aorta at a location where tissues overlying the abdominalaorta are relatively thin. Two such areas include one near theumbilicus, and another is immediately below the xyphoid process, thelower part of the sternum. Effects of exposure of the abdominal aortacan be monitored by thermography of the affected area of the limb, bytemperature strips, temperature sensors, or by Doppler blood flowmeasurements. If the thermal image of the affected area, such as theplantar portion of the foot, shows increased temperature with treatment,pain can be alleviated. In those patients for whom this approach doesnot provide sufficient relief, one can expose an area of the femoralartery. The femoral artery is relatively superficial in the groin area.Identification of a site of exposure can be accomplished by palpation ofthe arterial pulse at those locations. Additionally, in some patients,exposure of the popliteal artery can provide relief. In someembodiments, it can be desirable to treat the popliteal artery withinthe popliteal fossa.

In a minority of cases, the above methods may not provide sufficientrelief. In these situations, it can be desirable to expose the saphenousvein, from distal to proximal, with electromagnetic radiation. In someof these cases, such “painting” techniques can result in increasedperfusion to the affected location, and reduction in pain. Although themechanism for this effect are uncertain, one possibility is thatelectromagnetic radiation results in contraction of the veins, therebyincreasing venous return. Moreover, stimulation of autonomic nerves inthe veins may result in activation of autonomic nerves in the arteriesleading to that site.

Treatment of Temporomandibular Joint Syndrome

Temporomandibular joint syndrome (“TMJ”) is a condition characterized bycomplaints of clicking of the jaw upon opening (“crepitance”), andlocalized pain and pain radiating into the head, neck and upper backarea. In some patients, the radiation proceeds towards the frontal, thearea of the face, down the jaw and into the mouth region. In manypatients, headaches are common, and in some cases can be severe. Uponpalpation, the masseter muscles can be in spasm, along with thetemporalis and buccinator groups. Thermography can reveal circumscribedregions of hyperthermia located toward the anterior aspect of the jaw.Superficial EMG measurements can be used to directly assess muscularactivity. Latent myospasm can be detected in certain patients uponslowly opening and closing the jaws, by rotating the jaw by translatingthe jaw forwards and backwards, or other motion. If motion is limited,is not smooth, or is asymmetrical, the muscles responsible for thelimited motion will be targets for therapy.

Electromagnetic radiation therapy for patients with hyperthermia caninclude a 1-2 minute period of exposure to a beam of radiation in theorange or yellow wavelengths, followed by wavelengths in the blue regionof the spectrum. In situations in which the symptoms are associated withhyperthermia, blue radiation can be desirably used. In situations inwhich the affected area is cool or cold by comparison to normal sites,it can be desirable to treat with longer wavelengths, in theinfrared/red/scarlet/orange wavelength ranges to increase thetemperature (and blood flow) to those sites. In those patients withcrepitance, it can be desirable to expose the inner aspects of the mouthwith radiation at sites over the affected muscles. Using devices asdescribed in U.S. patent application Ser. No. 10/180,643 filed Jun. 26,2002, now U.S. Pat. No. 6,886,964, issued May 3, 2005 entitled:“Illuminator with Filter Array and Bandwidth Controller,” AllanGardiner, inventor, herein expressly incorporated fully by reference,simultaneous illumination of inner aspects and outer aspects of themuscles is possible and can be beneficial. In some embodiments, it canbe useful to apply radiation to the origins and insertions of themuscles. In other embodiments, it can be desirable to illuminate thebelly of the muscle. Subsequently, if desired, one can have the patientclose the mouth and exert some compressive force to hold the jaws in aclosed position. With the muscles under tension, treatment can beapplied. If desired, one can treat both sides of the jaw. In some cases,treatment of the contralateral side can provide greater relief thanunilateral treatment. Subsequent palpation, and observation of thepatient's jaw motion can reveal which muscles and muscle groups arestill holding tension.

In many of these patients, it can be desirable to take an incrementalapproach, first identifying a significantly spastic muscle and treatingthat one first. Then, other areas may become apparent as sites of spasm.Either simultaneously with or subsequent to treatment of spastic jawmuscles, the sites of referred pain or trigger points can be treated toprovide additional relief. In cases where the site of referred pain iscovered by hair, electromagnetic therapy can be applied through thehair.

In certain patients, it may be difficult to make a differentialdiagnosis of referred pain with myospasm from myositis. The symptoms maybe nearly the same, and the physical examination may be the same.However, monitoring temperature may yield different results, with areashaving myospasm showing cooler temperatures and myositis showing warmertemperatures than the surrounding normal sites. Because of thedifferences in temperatures, different therapeutic approaches can beindicated. Myospasm can be advantageously treated with long wavelengthradiation, such as infrared, red, scarlet, and orange, whereas myositiscan be advantageously treated with shorter wavelength radiation, such asblue.

Trigeminal Neuralgia

Trigeminal neuralgia (“TN”) is a condition characterized by pain of theface associated with the distribution of the trigeminal nerve. The paincan be associated with a region of hyperthermia located near the eararea, and is usually specific and circumscribed. In certain other cases,of long duration, there can also be an area of hyperthermia immediatelybehind the mastoid region at the base of the skull and the C1 area. Inmild or short-duration cases, the area of hyperthermia is anterior tothe ear and the facial aspect is cool.

In these patients, a therapeutic end point can be equalization oftemperature distribution. Areas that are warmer can be cooled, by way ofexample, by using short wavelength radiation. In contrast, cool areascan be warmed using longer wavelength radiation, including infraredradiation. In certain embodiments, it can be advantageous to provideoscillating treatment, in which long wavelengths (e.g., red or infrared)are used in one probe and the other of short wavelength (e.g., blue) forabout one minute. Then treatment of both sites with yellow radiation fora period of about one minute is provided. Subsequently, one canalternate between the red/blue then yellow regimen until blood flow isnormalized.

Example 2 Treatment of a Patient Having Trigeminal Neuralgia

A 70 year-old female patient presented with symptoms of pain associatedwith oral surgery 10 or 15 years before. During surgery, her mouth wasmaintained in an extended position (wide open) during surgery in whichseveral extractions were performed. She had been on prescriptionmedications for pain for many years, and in spite of the pharmacologicaltreatments, her pain was so severe as to prohibit her from inserting andusing her dentures.

In this situation, her trigeminal nerve was treated using infraredradiation as described above, and resulted in alleviation of her pain tothe point where she could use her dentures and carry on normalconversation.

Treatment of Post Herpetic Neuralgia

Herpes zoster is thought to be the causative agent of “shingles,” aviral disease involving infection of the sensory nerves to the skin, andpossibly other organs. In the skin, the virus can cause epithelialinfection with blistering and severe pain. The lesions typically willheal, but persistent, post-herpetic pain can be long-lasting and severe.

Diagnosis of post-herpetic neuralgia can be made by history, physicalexamination (presence of scarring) and/or by thermography. Post-herpeticneuralgia can be associated with heightened sensitivity to touch, and insome cases, even very mild physical stimulation (such as that associatedwith blankets) can cause severe pain. Thermography can reveal a patternof hypothermia in the intra-rib area, which can continue, in ahorizontal pattern from posterior to anterior. In certain situations, inwhich a particular nerve is involved, one can observe an oval region ofhyperthermia.

Treatment of post-herpetic neuralgia can be bilateral, involving a2-minute exposure to infrared radiation, with one beam directed towardthe posterior exit of the rib, and the other at the anterior terminationof the rib. This regimen can be associated with decreases in thecharacteristic deep, searing pain, which can be replaced with asuperficial pain that can be considered to be tolerable by manypatients. In certain embodiments, it can be desirable to treat regionsof referred pain, for example in nearby ribs. Therapy is repeated atintervals, with a period of about 3 days between treatments, thenprogressing to intervals of about 1 week, and then 2 weeks apart. Afterabout 6-10 weeks of such a therapeutic regimen, substantial recovery canbe observed. Thus, electromagnetic therapy can be effective in manypatients with pain of long duration. In addition to Herpes zoster,post-herpetic neuralgia associated with Herpes simplex can beeffectively treated using electromagnetic radiation therapy of thisinvention. Herpes simplex is a virus that, according to some, can residein dorsal root ganglion cells for long periods of time. Characteristicsymptoms include hypersensitivity to pressure and localized swelling, oredema, can be present. An additional manifestation in the trigeminalnerve, which innervates portions of the head and face, can include coldsores. Occasionally, the virus can be activated and transported down thesensory nerve to the skin, where a herpetic outbreak can occur. As withneuralgia associated with Herpes zoster, a major symptom can be deep,searing pain.

Therapy of post-herpetic neuralgia associated with Herpes simplex caninvolve short wavelength radiation, such as turquoise. In certainembodiments, the treatment with turquoise light (about 500 nm) can befollowed by red radiation. It can be desirable to also use vitamin A(100,000 Units), vitamin C and zinc (100 milligrams “mg”). Additionaladjunct therapies include elimination of the amino acid arginine fromthe diet. Nuts, and especially peanuts have large amounts of arginine.In contrast, it can be useful to include additional lysine in the diet.It can be especially desirable to begin electromagnetic radiationtherapy as soon as symptoms begin, even before herpetic eruptions areapparent. In certain cases, treatment at a frequency of about twice perday can be effective at decreasing the severity of a herpetic outbreak,and in some cases can prevent further progression.

Gangrene

Gangrene is a severe condition in which tissues die as a result ofinadequate nutrition and/or oxygenation. Gangrene can be caused bytrauma, by frostbite, by infection, or by certain metabolic disorders.Once a tissue's nutritional state is sufficiently compromised, infectioncan set in, causing further destruction of healthy tissue, and leadingto increased morbidity. Although there may be many causes of gangrene, acommon feature can be decreased vascular perfusion to the affected area.Although the causes of decreased perfusion are not known for allgangrenous conditions, overactivity of vasoconstriction may play a rolein one or more types of gangrene.

Thus, one therapeutic aim in treating gangrene is to increase vascularperfusion, thereby returning the affected tissue to a more normalnutritional state. Therapy using electromagnetic radiation can beeffective in improving the effects of gangrene, and can also help slowthe progressive destruction of tissues that characterize the disorder.In general, it can be desirable to provide some sterilizing radiation,in the form of ultraviolet radiation. Ultraviolet radiation is known tobe antibacterial, and when used in conjunction with radiationwavelengths that promote increased perfusion, can be effective inalleviating gangrenous symptoms and findings.

Example 3 Treatment of Gangrene

Skin lesions associated with gangrene can be treated usingelectromagnetic radiation therapy with low frequency ultravioletradiation. In a patient with gangrene of the legs, electromagneticradiation of infrared wavelengths was used, first at a point, identifiedas kidney-1. Thereafter, additional points were treated and includedelectrodiagnostic points of the common peroneal, deep peroneal andposterior tibial nerves. Subsequently, infrared radiation was used to“paint” the gangrenous area directly. The patient exhibited improvementin symptoms and mobility.

Diabetic Neuropathy

Diabetic neuropathies are a common source of morbidity in diabetesmellitus. Patients typically present with complaints of burning pain andthe plantar aspects of the feet with a decrease in sensory nervesensitivity. In some patients, the sensory deficit is so severe as tomake it difficult for patients to determine whether they are on acarpeted or uncarpeted floor. In some cases, patients find it verydifficult to determine whether their shoes are too tight. In certaincases, the symptoms become worse upon lying down.

Thermography reveals bilateral decreased peripheral perfusion andcooling, especially on the plantar aspects of the feet. Additionally,the distal portions of the toes can be cool.

Many patients with diabetes are treated allopathically with insulin,neurontin, anti-anxiety medications and/or other regimens ofpharmaceutical agents and diet. Therapeutic goals include increasingperipheral perfusion. In certain embodiments, in situations in whichallopathic remedies are less than completely effective, treatment canbegin by exposing the common peroneal, deep peroneal, posterior tibialand sensory nerves with infrared radiation to “balance” the innervationof the affected site. Then, radiation in the purple wavelength range canbe used. Then the wavelength can be changed to yellow, to “stimulate”the nerves, and in certain embodiments in which the neuropathy is oflong duration, to green and then to yellow. After a course ofelectromagnetic radiation therapy is completed, it can be desirable forthe patient to be reevaluated by an allopathic physician toappropriately readjust the prescriptive medications.

Example 4 Treatment of a Patient with Diabetic Neuropathy

A man presented with a history of diabetes who was unable to walkdistances greater than about 3 feet. Allopathetic remedies wereineffective. He could only sleep after plunging both feet into ice waterto numb them. He was unemployable and 100% disabled.

After 120 days of management using infrared electromagnetic radiationtherapy of this invention using infrared radiation, he obtained aposition that involved walking 3-5 miles per day wearing steel-toedshoes. He has retained that position for 5 years.

Sympathetic Atonia

Sympathetic Atonia (“SA”) is a condition associated with complexregional pain syndrome (“CRPS”) and Reflex Sympathetic Dystrophy(“RSD”). Complex regional pain syndrome and RSD include characteristicsymptoms of coldness in the extremities, coupled with lancinating pain,burning pain and dysfunction. These conditions are typicallyrecalcitrant to conventional allopathic management. Numerous nerveblocks, high doses of prescriptive medications and surgical interventionmay not be able to control this highly unique and individualizeddisorder. In many cases, the diagnosis of CRPS and RSD carry a highlevel of permanent impairment.

In many of the above type of disorders, a therapeutic goal is toincrease perfusion of the affected region. In certain embodiments, itcan therefore be desirable to use infrared, red, or orange wavelengthsof electromagnetic radiation.

In certain patients having similar symptoms, the extremities are warmand not cold, resulting in a variant of RSD known as “hot RSD”. Thesepatients are characteristically unresponsive to conventional allopathicmanagement and electromagnetic radiation therapy using infrared/redwavelengths was ineffective.

To treat patients having hot RSD, initial sensitivity testing caninclude exposing the symptomatic extremity using wavelengths ofradiation in the blue spectrum. The therapeutic goal can include first,producing normal temperatures (“euthermia”) or even hyperthermia. Then,one can provide radiation in the scarlet portion of the spectrum to thecontralateral side. Then, infrared radiation can be used to sweep thecontralateral inferior cervical ganglion innervating the upperextremity, or the femoral artery and the sacrococcygeal junction fortreating lower extremities.

The duration of therapy for CRPS, RDS or hot RDS can be selected basedon observations of the appropriate extremity. Methods that can beespecially useful include pulse oximetry or liquid crystal temperaturescales or thermography. The initial dose of electromagnetic radiationused can be terminated at a time when an alteration in the monitoringvariable is detected. A second series of therapeutic applications can beprovided the next day, for example, 24 hours later. Subsequenttreatments can be carried out periodically after that time.

Post Surgical Joint Replacement Syndrome

Many patients having joint replacements respond successfully to standardphysical therapy measures. However, many develop new symptoms when theybegin to discard their ambulatory aids, such as crutches, walkers andthe like. Although physical therapy is typically repeated, symptoms maypersist with time and new symptoms can appear. New symptoms can includepoor lymph drainage (“lymphedema”) and pain, either proximal to thereplaced joint, distal to the joint, or in both locations. In somecases, the pain can be progressive.

Electromagnetic radiation therapy can be successful in alleviating jointpain and lymphedema, can reduce or eliminate the associated myospasmand/or myositis and can result in increased active range of the affectedjoint. In certain embodiments, therapy can begin with the practitioneridentifying the perfusion of the surgical scar, for example, usingthermography, temperature sensors, or temperature scales placed on theskin. If the scar is hypothermic, then radiation in the scarletwavelength range can be used. In certain of these embodiments, it can bedesirable to apply two beams of radiation, one at each end of thesurgical scar. In cases in which the scar is hyperthermic, it can bedesirable to use wavelengths in the blue range of the spectrum.Palpatory examination performed at the surgical site can determine thepresence of absence of myospasms. If myospasm is detected, as reflectedby reduced temperature, then radiation in the orange wavelength rangecan be advantageously used at the trigger point to produce musclerelaxation. If myositis is found, as reflected by hyperthermia, thenradiation in the green portion of the spectrum can be used.

Then, the practitioner can establish the nerves that traverse a coursethrough the surgical field, or those which specifically innervate theaffected musculature. Dual illuminators can be used with radiation inthe yellow wavelength range, with one beam directed at the spinal exitof that nerve and a second beam directed at a superficial cutaneousbranch of that nerve. Patient tolerance can be monitored by observingthermal images of sites along the distribution of the affected nerve.When decreases in perfusion, or cooler temperatures, are observed,treatment can be terminated.

Once the desired therapeutic goals have been met, the patient is thenplaced in a recumbent posture to passively move the affected jointthrough its range of motion. The practitioner can slowly move theextremity through the pain-free arc of motion and then can gentlyprovide a slight overpressure to extend the range of motion of theaffected joint. Any specific abnormal motions are noted, and the patientis then provided instructions for exercises to do to assist inincreasing mobility of the affected joints. Treatment can beadvantageously repeated daily for three days to provide an objectivebasis for improvement.

Acupuncture

Electromagnetic radiation therapy can be a method of choice fornon-invasive acupuncture. Standard forms of diagnosis can be used (e.g.,Akabane, EAV, or electric resistance measurements and the like). Thepractitioner selects points to be treated and chooses wavelengths thatcan produce the desired physiologic properties. The beam of radiationcan then be selected to have a small diameter, if desired. Monitoringmethods may include an audible sound generator to indicated changes inelectrical conductivity, or alternatively, direct measurements ofelectrical resistance can be provided. Observed changes in monitoredvariables can indicate effects of therapy.

Additionally, a practitioner may select and locate acupoints manually orwith a device to monitor electrical resistance (“ohm meter”). In certainembodiments, the points may be treated immediately, or alternatively,may be marked for future treatment. If auriculotherapy is chosen, thepractitioner may further decrease the diameter of the beam to a desiredsize.

Carpal/Tarsal Tunnel Syndromes

Carpal tunnel syndrome (“CTS”) and tarsal tunnel syndrome (“TTS”) can bediagnosed using measurements of nerve conduction velocity (“NCV”) orCPT. The nerve exhibiting the slowest velocity can be advantageouslytreated first. A determination is made whether the condition is acute orchronic. For chronic conditions, wavelengths in the yellow range can beuseful. A dual beam system can be desirable and the practitioner canselect distal and proximal electrodiagnostic points and can applyradiation. In certain embodiments, it can be desirable to select otherpoints, such as two, along the affected nerve and to treat those sites.If the condition is acute, the therapy can be otherwise similar to thatused for chronic conditions, but using wavelengths in the green range ofthe spectrum.

After those points are treated, the practitioner can then examine theassociated musculature for the presence of trigger points, myospasm andmyositis. If myospasms or myositis of found, it can be treated asdescribed above, or alternatively, a painting method can be used. Incertain of these embodiments, one beam can be applied to a distalportion of the extremity, while another beam can be at a proximal sitealong the muscle. It can be desirable to provide the proximal beam witha configuration that produces a rectangular beam to increase the area ofexposure. A painting technique can begin with the rectangular beam movedfrom proximal to distal along the affected region. If myospasm isobserved, then the proximal beam can be in the orange portion of thespectrum and the distal beam can be yellow. If myositis is observed,then the proximal beam can be advantageously green and the distal beamcan be yellow. Monitoring muscle tone by surface EMG can be useful. Adecrease in the amplitude of signals can provide an objective measure ofthe patient's response to treatment.

Once a desired result is obtained, the region can again be searched fortrigger points. If a zone of referred pain is found by direct physicalcompression, then a dual beam approach can be used. The beams can bepointed directly at each other with the trigger point between. The endsof the devices can be used to gently compress a trigger pointtherebetween to increase the effectiveness of therapy.

Hyperperfusion

In situations in which an affected site is relatively warmer thansurrounding sites, and in which it is desirable to equalize temperature,it can be desirable to use electromagnetic radiation having relativelyshorter wavelengths, such as blue. Conversely, in those situations inwhich an affected site is warmer than the surroundings, and in which itis desirable to equalize temperature, one can use radiation havingrelatively longer wavelengths, such as infrared, red or orange. Althoughthe mechanisms that underlie the beneficial effects of the radiationtherapy of this invention are not known with certainty, one hypothesisis that cool sites may suffer from vasoconstriction and reducedperfusion, and warmer sites may suffer from too much perfusion. Thus, totreat cool regions, radiation is used that promotes increased perfusion,possibly via inhibiting vasoconstriction caused by sympathetic nerveoveractivity. To treat hyperthermic regions, radiation can be used thatpromotes vasoconstriction, possibly via increasing sympathetic nerveconstrictive activity.

Entrainment

For disorders of the central nervous system, therapeutic efficacy can beimproved by providing multiple sources of stimulation to the bodysimultaneously. Thus, in certain embodiments, it can be desirable toprovide auditory stimulation via earphones at a known frequency.Simultaneously or alternatively, one can provide visual stimulation withlight at the same frequency and/or phase relationship as the auditorystimulation. Further, one can use electromagnetic radiation ofperipheral sites at the same frequencies and/or phase relationships asthe auditory and/or visual stimulation. By providing several modes ofinput to the central nervous system, the efficacy of electromagneticradiation therapy can be increased. It can be appreciated that one ormore of the alternative modes can be used. Moreover, it can beappreciated that one may stimulate the eyes using unilateral left orright sided light, or bilateral stimulation.

When the central nervous system is involved in symptoms to be treated,electromagnetic radiation therapy as described herein can beadministered simultaneously with electromagnetic radiation delivered tothe eyes. Delivery of light to the eyes is known as Syntonic therapy.Syntonic radiation can be provided using a device such as a SpectralIlluminator described by Frank Olstowski. The patient looks at thedevice that emits light having a designated color and pulse frequency.In certain embodiments of this invention, electromagnetic radiation canbe applied to the eyes as well as a superficial portion of a nerve of anaffected extremity to be treated. It can be desirable to provideSyntonic and electromagnetic radiation in pulses that are synchronizedwith each other to produce entrainment. Some fibers in the optic nervetravel to the occipital region of the brain and other fibers travel tothe reticular activating formation and may influence the pineal,pituitary, hypothalamus and other portions of the central nervoussystem.

In certain of these embodiments, it can be desirable to control thephase relationships between the stimuli to the eyes and to theperipheral site. Distances between peripheral sites and a site in theCNS can be substantially greater than the distances between the retinaand the same site in the CNS. Thus, because of delays in nerveconduction, impulses initiated in a peripheral site may take longer toreach a CNS site than impulses initiated closer to that CNS site. Thus,it can be desirable to provide pulses of electromagnetic radiation to aperipheral site that precede, by a controlled time, the pulse providedto the retina. The control of phase of these pulses can be accomplishedusing pulse generators coupled to a common timing device. Alternatively,a computer can be used to adjust the relative timing of the pulses.

In other embodiments, it can be desirable to provide pulses that are outof phase by a desired amount. By adjusting the relative timing andduration of pulses delivered, the practitioner can determine optimumtherapeutic conditions. In certain embodiments, it can be desirable tolimit or stop the effect of entrainment on the central nervous system toavoid adaptive or compensatory abilities of the body to learn and/oranticipate the stimulus. By using randomized variations in wavelength,rate of change of wavelength, changes in location of illumination orother variable, a higher degree of neural stimulatory specificity can beachieved.

Dental Disorders

Frequently, normal healthy teeth begin to loosen within the sockets.Decreased blood flow creating ischemia and its related sequelae can be adirect result of sustained vasospasm. Thermal imaging of the face andjaw reveals regions of temperature asymmetry. The application ofelectromagnetic radiation can stabilize the tooth and prevent prematureextraction. Electromagnetic radiation can be applied with dual probes,one on the lingual border and the other on the facial border of theaffected tooth. The frequencies in the red, red-orange, and yellowranges can be used concurrently. The appropriate artery and nerve arethen treated with radiation in the green range. Dual ultraviolet probescan then be applied to the gingival surfaces of the adjacent andaffected tooth and can stimulate dermal cell proliferation and aid as anbacterial and viral retardant. As therapy progresses, temperatureasymmetry as monitored by thermal imaging decreases.

Patients having to undergo reconstructive surgery from traumatic insultas well as cosmetic procedures frequently develop masticatory disorders.One cause for these disorders is associated with the jaws having beenwired closed from weeks to months. Surface EMG is used as well aspalpatory evaluation to locate the affected musculature. Followingremoval of the wires, the mandible may fail to track properly and/or thejaw may be unable to open more than a few millimeters. The applicationof electromagnetic therapy can relax myospasms, reducing the tissueanoxia, and can improve function. One probe is placed within the oralcavity at the site of greatest tenderness and the second probe placed onthe facial surface. One minute of electromagnetic therapy in theorange-yellow wavelength range is applied and palpatory examination isagain performed. Treatment can be continued until the desired result isobtained. When the oral cavity is able to be opened sufficiently, thephysician can continue the examination to search for latent triggerpoints that were not accessible with the mouth closed.

It can be appreciated that in addition to the above disorders, numerousdisorders involving excitable tissues can be effectively treated usingthe methods of this invention. Additional disorders include tensionheadache, sinus headache, vertebrogenic headache, articular dysfunction,complex regional pain syndrome, joint contracture of the fingers ortoes, pain associated with intervertebral disk disorders, muscleinjuries involving swelling, polyneuropathy, peripheral neuropathies,post surgical pain, post-traumatic sensory nerve dysfunction,spondylosis, pain and swelling associated with traumatic injuries, andstorticollis.

Treatment of Muscular Spasms

Methods of this invention are well suited to treating conditionsinvolving muscular spasms associated with pain. For example,electromagnetic radiation can be applied to various points on the bodyassociated with electrodiagnostic points, acupuncture points, triggerpoints, meridians or nerve distributions.

FIGS. 2 a-2 d depict certain sites useful for application ofelectromagnetic radiation according to this invention for treating head,neck and upper torso neuromuscular conditions. FIG. 2 a depicts aright-lateral view of a subject's head and torso. FIG. 2 b depicts aleft-lateral view of a subject's head and torso. FIG. 2 c depicts afront view of a subject's head and torso. FIG. 2 d depicts a rear viewof a subject's head and torso. Specific points that can be useful forapplication of electromagnetic radiation (EMR) include those in Table 1below.

TABLE 1 Sites of Application of Electromagnetic Radiation Right SideLeft Side Point Point Site of Application of EMR 1 2 Inferior aspect ofthe mastoid process 3 4 Midpoint of the sternocleidomastoid muscle 5 6Lateral base of the neck 7 8 Acromioclavicular joint 9 10 Superiorcorocoid process 11 12 Midpoint of deltoid muscle 13 14 Supraclavicularfossa 15 16 Inferior to midpoint of clavicle 17 18 Pectoralis major justanterior to axilla 19 20 Just inferior to the inferior nuchal line 21 22Just lateral to the vertebral prominence 23 24 Supraspinous fossa 25 26Midpoint to the spine of the Scapula 27 28 Infraspinous fossa 29 30Medial to the midpoint of the medial border of the scapula

Example 5 Treatment of Trapezius Spasm with Pain

To illustrate methods for treating spasms of the trapezius muscle withassociated pain, we studied a series of 25 patients presenting with painof the upper back or neck. Patients were selected that had persistentpain which was not responsive to conventional therapy. We treated eachpatient using EMR delivered by fiber optic illuminator described above.The end effectors for each treatment were positioned above the points tobe illuminated, but were not in contact with the subject's skin at anytime. The patients were not informed of what was being illuminated orthe conditions of illumination. We found that illumination of certainpoints on these patients using electromagnetic radiation can altermuscular activity of affected muscles. These results also indicate thatEMR can be effectively monitored using SEMG methods in real time duringtreatment.

Patient 1

At the time of the study, patient 1 was a 45 year old female withunrelenting left-sided pain at the suboccipital area made worse bymovements. She failed to respond positively to repeated courses ofchiropracetic therapy, physical therapy, exercise, stretching etc. Shereported that the pain was made worse by rotating her head and by slowmovements. She reported that no significant reduction in pain occurred.

The subject was treated for three sessions under Investigational ReviewBoard (IRB) supervision using electromagnetic radiation in the visiblespectrum, from about 400 nm to about 700 nm. Application time at eachsite was approximately one minute. Five (5) identified locations,wavelengths, and wavelength variation combinations are indicated by thenumbers on the graphs of FIGS. 3 a and 3 b. Two applicators were used atthe same time, with conditions and locations of each illuminator endeffector shown in Table 2 below.

TABLE 2 Treatment Protocol for Patient 1 Treatment Time Treatment Index*Locations** Conditions of Illumination*** 1 22 & 24 660 nm ± 80 nm, 2Hz, 50% Duty cycle 2  8 & 16 520 nm ± 40 nm, constant output 3 19 & 20End effector 1: 620 nm ± 20 nm, End effector 2, 420 nm ± 20 nm, constantoutput 4 1 & 2 End effector 1: 660 nm ± 40 nm, End effector 2: 420 nm ±20 nm, constant output 5  7 & 15 660 nm ± 40 nm, constant output *Thenumber indicates that the illuminator was turned on. The + indicatesthat the illuminator was turned off. **Locations described in Table 1above. ***Data expressed as central wavelength ± wavelength variation,frequency (in Hertz; Hz), and percent of total duty cycle.

FIG. 3 a depicts the SEMG trace of the affected, left side of thesubject. During the pre-illumination period, the graphs shows relativelywide variations in and high intensity of SEMG activity. A first periodof illumination at points 22 & 24 had little effect on SEMG activity.However, application of electromagnetic radiation (EMR) having a centralwavelength of 520 nm (point 2) resulted in rapid, substantial decreasein SEMG activity. Further application of EMR at two locations, eachinvolving a different central wavelength (point 3) further reduced themagnitude of variations and the relative SEMG activity.

In contrast with the substantial effects on the affected side, SEMGmonitoring of the unaffected (right) side of this patient revealedcomparatively little SEMG activity. Treatment of the affected side didnot result in noticeable changes in SEMG activity on the non-affectedside.

Patient 2

At the time of study, patient 2 was a 55 year old female having ahistory of left trapezius pain, congenital scoliosis and persistentlimitations on range of motion. Years of physical therapy, chiropraceticand allopathic intervention was without appreciable result. The subjectwas treated for three (3) sessions under IRB supervision using EMR inthe visible spectrum (400 nm-700 nm). Application time was about 1minute at each site. Five (5) combinations of central wavelength, andwavelength variation were used, each with continuous illumination (i.e.,100% duty cycle) according to Table 3 below.

TABLE 3 Treatment Protocol for Patient 2, First Session Treatment TimeTreatment Index* Locations** Conditions of Illumination*** 1 21 & 22 660nm ± 60 nm 2  6 & 14 420 nm 3 19 & 20 700 nm ± 60 nm 4  2 & 20 660 nm ±60 nm 5  6 & 14 600 nm *The number indicates that the illuminator wasturned on. The + indicates that the illuminator was turned off.**Locations shown in Table 1 above. ***Data expressed as centralwavelength ± wavelength variation.

FIGS. 4 a and 4 b show the responses of patient 2 during a first therapysession. FIG. 4 a shows the SEMG traces of the affected (left) side.Treatment at time indices 1 and 2 showed little change in the relativelyvariable activity. However, treatment at time index 3 resulted in aprogressive alteration (increase) in SEMG activity, which returned tobasal levels when the illuminator was turned off. Illumination at timeindex 4 (both sites on affected side) resulted in increased SEMGactivity, which returned toward baseline values when the illuminator wasturned off.

FIG. 4 b shows the SEMG traces of the unaffected (right) side.Illumination at each time period resulted in progressive, increasingSEMG activity, which returned toward baseline values when theilluminator was turned off.

After the course of therapy, the patient reported that her muscles feltsofter and that her range of motion improved, so that she could swim andmove about more easily.

Patient 3

Patient 3 at the time of study, was a 53 year old female who receivedinjuries as a passenger in an automobile when a piece of concrete fellfrom a bridge, through the front window and struck her. The objectstruck the patient in the head rendering her unconscious. Sheexperienced persistent pain and muscle tightness on the right side. Shehad multiple courses of conventional treatments which did not result inalleviation of her muscular distress.

The subject was treated for three (3) sessions under IRB supervisionusing EMR in the visible spectrum (400 nm-700 nm). Application time ateach site treated was approximately one minute. Six (6) sites identifiedin Table 1 above were illuminated according to Table 4 below.

TABLE 4 Treatment Protocol for Patient 3 Treatment Time Treatment Index*Locations** Conditions of Illumination*** 1  8 & 16 520 nm ± 40 nm 2  6& 14 520 nm ± 40 nm 3 22 & 24 First end effector: 620 nm ± 20 nm Secondend effector: 420 nm ± 20 nm 4  2 & 20 First end effector: 660 nm ± 40nm Second end effector: 420 nm ± 40 nm 5 3 & 4 660 nm ± 40 nm 6 6 Firstend effector: 560 nm ± 20 nm Second end effector: 420 nm ± 20 nm *Thenumber indicates that the illuminator was turned on. The + indicatesthat the illuminator was turned off. **Locations shown in Table 1 above.***Data expressed as central wavelength ± wavelength variation.Illumination was constant during the time indices.

FIGS. 5 a and 5 b depict SEMG responses of patient 3 during the first ofthe three sessions. FIG. 5 a shows the SEMG trace of the unaffected side(left side). The SEMG trace remained at a relatively constant, and lowmagnitude for the duration of the study, regardless of the location ofor existence of illumination. FIG. 5 b depicts the SEMG trace obtainedfrom the affected side (right side) of patient 3. Before illumination,the variation in the SEMG trace was substantially greater than that ofthe unaffected side. During the first illumination period (time index1), there was a lag period, followed by a slow rise in SEMG activity,which ended upon turning off the illuminator (+). A second period ofillumination (time index 2) resulted in an increase in activity thatpersisted even after the illumination was terminated. At time index 3,the magnitude of SEMG activity decreased, and this decrease was reversedby terminating the exposure (+). Subsequently, at time index 4, SEMGactivity decreased, and the decrease was reversed upon termination ofexposure. At time index 6, activity decreased back to thepre-illumination base line value.

After the course of therapy, the patient reported increased mobility,softer muscles, and a 20% reduction in symptoms.

Patient 4

At the time of study, patient 4 was a 65 year old male experiencinginsidious spasm of the right trapezius muscle which had been a problemfor the prior 20 years, with persistent right sided pain and muscletension and sleeplessness. No prior course of allopathic therapy waseffective.

Patient 4 was treated for three (3) sessions, according to the protocolshown in Table 5 below.

TABLE 5 Treatment Protocol for Patient 4 Treatment Time Treatment Index*Locations** Conditions of Illumination*** 1 5 & 6 660 nm ± 60 nm 2 13 &14 540 nm 3 none 4 1 & 2 600 nm *The number indicates that theilluminator was turned on. The + indicates that the illuminator wasturned off. **Locations shown in Table 1 above. ***Data expressed ascentral wavelength ± wavelength variation. Illumination was constantduring the time indices.

FIGS. 6 a and 6 b depict SEMG traces from patient 4. FIG. 6 a depictsthe SEMG trace obtained from the unaffected (left) side, and showsrelatively low levels of activity. Application of EMR at time index 1resulted in a slight increase in SEMG activity, and termination of theexposure resulted in a further, but small increase in activity. No othersignificant changes in SEMG activity were observed.

In contrast to the unaffected side shown in FIG. 6 a, FIG. 6 b shows theSEMG trace obtained from the affected side. Prior to illumination,baseline SEMG activity was decreasing. At time index 1, after a lagperiod, SEMG activity increased substantially. The increased activitypersisted for a period after the illuminator was turned off (+), butthen decreased to baseline values. Application of EMR at time index 2resulted in a similar increase in SEMG activity. At time index 3, wherethe light beam was not directed at the patient, resulted in no change inSEMG activity. Illumination at time index 4 resulted in a lag periodfollowed by an increase in SEMG activity, that reversed after theilluminator was turned off (+). We note that the magnitude of theincrease in SEMG activity decreased progressively with time, indicatingthat the SEMG activity of the two sides became more alike withtreatment.

After the course of three sessions, the patient reported lessening ofmuscle spasm and at least a 50% reduction in pain. He also reportednormal sleep patterns.

The results of the studies of these 4 patients indicates thatillumination of specific points on a patient's body, on the skin, canaffect neuromuscular activity. Further, a program of therapy can betargeted to changing the muscular activity to relatively balancedlevels, which can be associated with improved clinical signs andsymptoms.

Example 6 Treatment of Carpal Tunnel Syndrome I

Subjects suffering from carpal tunnel syndrome (CTS) were identifiedbased on clinical findings and the subjects' reports. Seven (7) subjectswere studied according in an IRB supervised study.

The purposes of the study were to determine whether application of EMRto selected locations on the hand, wrist, and/or arm produce therapeuticrelief in patients with chronic pain due to carpal tunnel syndrome.

Somatosensory testing, nerve conduction velocity, high resolutionthermal imaging and monofilament testing were performed before treatmentwas started. The same tests were made for comparison at other timesduring the study. Monofilament testing was performed at each sessionbefore treatment.

The initial treatment location for the subjects was the median nerve atthe wrist. The initial central wavelength was 560 nm at a frequency of20 Hertz.

Patient 1

Patient 1 at the time of study was a 44 year old female employed in thefood service industry. Prior to treatment, she had problem with herright wrist for 16 years and was diagnosed by her orthopedist 8 yearsago as suffering from CTS. She attributes the problem to playingathletics (softball pitcher and bowling). The pain was not localized andit travels from the wrist up the entire arm. She described it as verysevere (#8 out of 10) with the character of sharp and shooting pain,associated with loss of function and inability to use her arm and hand.The pain was intermittent and was made worse by using her hand.

Before treatment, her grip strength was determined to be at the 76thpercentile for women of her age. Her distal motor latency was 4.1milliseconds (ms) (0.8 percentile).

After two treatments she reported that she went back to work andexperienced no problem with her hand. She reported that her grip wasvery much improved and that she had good use of her hand. After thethird treatment, she reported that the tingling and numbness were gone.Although she reported that some soreness around her wrist persisted, butthat she could hold onto her coffee cup and that there was less pain onthe side of her arm.

After three treatments, her grip strength improved to the 93dpercentile, her distal motor latency decreased to 3.7 ms (8.4 percentilefor age matched control women).

Patient 2

At the time of study, patient 2 was a 53 year old female hairdresser andcook. She complained of constant throbbing pain in her right hand thattraveled up her arm to the shoulder. The throbbing has been present formore than ten years. The symptoms were made worse by constant handmovements as a hair dresser and lifting heavy pots and scrubbing them.She obtained some relief by not using her hand and soaking her hand inhot water. Her pain was graded as severe (grade 5). She first receivedsham treatment for two sessions. She reported no change in her symptoms.She then received an active treatment with central wavelength variationand reported that she was able to do hair all day long and experiencedno numbness or tingling, but some aching persisted.

Patient 3

At the time of study, patient 3 as a 78 year old male working 10hours/week in hardware store. He complained of pain in his right handfor many years but two years ago numbness slowly began to increase andwas getting worse up to the time of study. The disorder was confirmed bymonofilament testing and temperature threshold measurements as shown inTable 6 below.

TABLE 6 Patient 3 Thumb Thumb Thumb Thumb Wrist Cold Warm VibrationMonofilament Monofilament Threshold* Threshold** Threshold ThresholdThreshold Before 14.0 48.6 16.9 μm >11.5 gms >11.5 gms Treatmentinsensitive insensitive After 3 22.4 43.4  4.3 μm <0.5 gm <0.5 gmTreatments normal normal *, **Data expressed as degrees C.

Before treatment, he could not button his shirt nor was he able to pullup his zipper well. He had problems feeling coins in order to giveproper change while working in the store. He experienced numbness whichwas constant and worse in his fingertips.

After one active treatment session he reported the following day that hefelt improved sensation and the numbness decreased. He was able to makechange better than before and he was able to feel the tab on his zipperin order to pull it up. After the second treatment session he reportedthat he felt great, the hand was more comfortable and the tingling wasgone. He is not awakened by his hand during the night. He was able tosqueeze the tip of his finger and feel it. He reported a dramaticimprovement in his functional ability.

Patient 4

At the time of study, patient 4 was a 79 year old retired female, whoreported using a cane in the right hand and began to notice tingling andnumbness develop in the first three fingers of the right hand. Shesought conventional treatment without relief. She was unable to type orto wring out a wash cloth. She felt somewhat improved by wearing a wristbrace while sleeping. She graded her pain as #8 (of 10) or very severeand was reported to be constant.

When she returned for her second treatment she reported that she did nothave to wear a night brace at night and was able to sleep all nightwithout pain. After her second treatment she reported that her symptomsbecame somewhat worse after playing cards all day but the spasms werenot as severe as before.

Patient 5

At the time of study, patient 5 was a 49 year old female employed insales. She was diagnosed as having CTS about 16 months prior topresenting. The onset was slow and gradual and the dull achy symptomswere made worse by driving and using a telephone. She reported chronicsleeplessness. If she shook her hand or bent it she did obtain somerelief. The symptoms traveled from the fingers to her elbow. Shereported that after her second treatment session that a lot of achepressure is gone. There was no numbness or tingling. She reported thatshe was sleeping the night through.

Patient 6

At the time of study, patient 6 was a 41 year old female homemaker. Shewas involved in two severe automobile/train accidents in 1970 and 1994.She was gripping the steering wheel and was jerked severely at the timeof accident. Her symptoms were made worse by attempting to operate avacuum, washing windows, using a computer or holding the telephone. Shewas able to obtain some relief by using a wrist band at night. Sometimesthe pain traveled up her arm but it concentrated in her thumb. It wasintermittent.

After two treatments, she reported that she felt some improvement with adecrease in stiffness in her hands.

Patient 7

At the time of study, patient 7 was a 66 year old female cook. Ten yearsago she was scrubbing pots and pans in a circular motion whileperforming her occupational duties and developed left handed pain. Sheoperated a French fryer for 1.5 hours which required her to continuallylift and empty the frying basket. This caused her to experienceadditional pain. Lifting and grasping made her symptoms worse and usinga wrist brace at night help relieve the pain. The symptoms did nottravel or move and they were constant while she was at work. Prior totreatment, her grip strength was reported to be in the 46th percentilefor her age. Her distal motor latency was 4.1 ms and the percentilebased on age was 0.4%.

After three treatments, her grip strength improved to the 54thpercentile, her distal motor latency decreased to 3.7 ms (7.8percentile). After her first treatment session she reported that she wasable to sleep without her brace and her hand did not get numb. After thesecond treatment session she reported that her hand did not go to sleepand there was no numbness or tingling. She has not been awakened fromsleep.

These studies indicate that under control conditions in which no EMR wasdelivered, the subjects reported no changes in either symptoms,objective evaluation of physiological variables or in clinical findings.However, treating the subjects with the electromagnetic radiationimproved function, decreased symptoms of pain and improved objectivemeasurements of physiological variables. No adverse effects of EMRtherapy were reported.

Example 8 Treatment of Carpal Tunnel Syndrome II

In a larger study of patients with carpal tunnel syndrome (CTS), sixteen(16) patients are evaluated under IRB supervision. The subjectpopulation is divided into two equal groups of eight (8) subjects beforestart of the study. One group receives treatment with theelectromagnetic radiation turned “on” for each of the first twotreatments. The other group receives treatment with the electromagneticradiation turned “off” for the first two treatments. The first groupreceives two treatments with the electromagnetic radiation turned “off”at later times in the study. All subjects receive a maximum of eight (8)treatments with the electromagnetic radiation turned “on” during thecourse of one month.

The initial treatment location for the subjects is the median nerve atthe wrist. The initial central wavelength is 560 nm at a frequency of 20Hertz. Additional subjects initial treatment includes a wavelengthvariation of ±20 nm during treatment.

We observe that EMR therapy results in improved mobility, decreasedpain, increased ability to move.

IV Methods of Monitoring Electromagnetic Radiation Therapy

Many methods are known in the art to be beneficial for assessing theefficacy of treatment. The monitoring system chosen can beadvantageously selected based on the diagnosis, the affected tissue ororgan, and on the type of treatment used. Methods include, but are notlimited to the following.

Photoplethysmography (“PPG”) is a method for noninvasively monitoringblood volume changes in an extremity such as a finger, toe, or inalternative embodiments, a hand, foot, arm or leg. Plethysmography canbe used to track cardiac pulse rate, heart rate variability, changes inpulse pressure and peripheral blood flow.

Surface electromyography (“sEMG” or “SEMG”) involves the use of two ormore electrodes placed over a muscle. Muscular activity is reflected inchanges in electrical activity of the muscle, and changes in electricalactivity can reflect the underlying tone or activity of the muscle. SEMGcan be used to identify points on a patient's body that are responsiveto electromagnetic radiation therapy. EMT can be applied to variouspoints on the body, and an alteration in SEMG activity can indicate thatthe point so treated is associated with activity of the muscle monitoredby SEMG.

Temperature monitoring can be carried out using liquid crystaltemperature scales attached to the skin, temperature sensors taped tothe skin temperature probes touched to the skin or electronicthermography using infrared cameras.

Respiration monitoring using sensitive force transducers can be used tomonitor respiration rate and alterations in rate, depth and pattern ofbreathing.

Doppler blood flow measurements can be made using equipment thatdelivers sound waves or laser light to tissues that are moving. Becauseblood flow involves linear motion of blood, the velocity with whichblood moves can be accurately measured.

Electrodermal activity (“EDA”) can be monitored using skin conductanceresponse (“SCR”) and skin conductance level (“SCL”) can be used tomonitor changes in sympathetic nerve activity to sweat glands in theskin. Sensors can be attached to different points on the patient's skinand the conductivity between those sensors can be displayed in realtime.

Tissue compliance measurements (“TCL”) can be used using standard gaugesto quantify alteration in muscle spasticity, muscle tension, tone,edema, scarring, presence of fibrotic tissue, and changes in stumpdensity before and after treatment.

Pressure threshold measurement can be used to quantify the minimumamount of pressure that can be detected in painful regions associatedwith fibromyalgia, myofascial syndrome, myositis, nerve irritation, andcertain endocrine and metabolic conditions.

Pressure tolerance measurements can be used to quantify the maximumamount of pressure that can be tolerated.

Current perception threshold devices can be used to determine sensorynerve conduction threshold (“sNCT”) evaluations by determining theamount of current that can pass without causing pain (“CPT”). CPT andsNCT can be used to quantify conduction and functional integrity oflarge and small myelinated and unmyelinated sensory nerve fibers atcutaneous sites. This information can be used to detect and quantifyearly stage neuritis and peripheral sensory neuropathies. Constantcurrent output assures highly reproducible measures, which areunaffected by variables such as skin thickness, temperature or edema.

Pulse oximetry can be used to document changes in pulse rate, peripheraloxygen content and saturation, and can be used to detect changes inperipheral perfusion.

Alizarin sweat test is a noninvasive procedure to assess activation ofthe sweat glands as a result of sympathetic nervous system activity.

Monofilament testing can be used at hyperesthetic or hypoesthethicregions to quantify changes in sensory function. Regions can be mapped,recorded and kept in a patient's record.

Dual-inclinometry measurements can be taken of joints that arefunctionally impaired with pain as a limiting factor. Those joints whichare restricted and not part of the patient's primary complaint can bemeasured if desired. Measurements can be serially repeated to chartfunctional improvement.

Jamar grip and pinch strength measurements can be repeated three timesat each of five settings and then can be graphed. The average pinch andgrip strengths can then be compared to age and sex-matched normativedata to determined sincerity of effort in performance of testing and asa monitoring methods to document strength augmentation with therapy.

Gait analysis can be performed using video recording equipment. Thepatient can use usual and customary ambulatory aids and walks toward andaway from the camera for at least five steps. The legs can be exposedfrom the knees downward and the customary foot wear is worn. Thepractitioner may elect to record an analysis while the patient wearseither no footwear, or while wearing orthotics or other prescriptiveaids.

Limited functional capacity evaluation can be conducted on an individualand regional basis exclusively for the symptomatic region. Photography,including digital photography can be used to record asymmetry ofmovement, posture, (sitting and standing) and any region that isincluded in the patient's primary complaint region. Comparativeevaluations can be conduced in a serial manner to monitor improvement inposture.

Muscle strength testing can be conducted with standard hand-heldresistance gauges to quantify lift to right asymmetries and to monitorfunctional improvement. Muscles to be tested can be within the patient'sprimary pain or dysfunction area. Measurements can be repeated toprovide reliable information.

Somatosensory evoked potentials can be performed to quantify neuralintegrity status and/or improvement following a course of treatment.Typically, temperature and/or vibratory stimuli are provided and thesensitivity of the subject to these stimuli can be quantified. Incertain cases, it can be desirable to monitor asymmetry of responses.Initial examinations can assist the practitioner in the placement ofsites for treatment and subsequent evaluations can quantify progress anddetermine maximum therapeutic benefit.

Motor and sensory nerve conduction velocity studies (“CVS”) can beperformed as an initial evaluative technique. Nerves to be treated canbe selected on the basis of conduction velocity in certain embodimentsof this invention. Working diagnosis can be provided and CVS can be usedto make comparative evaluations.

Electrodermal testing can be conducted prior to treatment and can bedesigned to address symptomatic regions in lieu of testing for generalwell-being. The test can be repeated serially to quantify effectivenessof current treatment regimens and as an aid in evaluating an individualpatient's responses. Electrodermal testing can also be used to determineeffectiveness of treatment with radiation of specific wavelengths andwavelength ranges.

Dermathermagraph readings can be performed for patients whose problemsare spinal in nature, can be recorded and stored in a patient's chart.

Electroencephalograms can be performed when head trauma, closed headinjury, cognitive dysfunction or prior testing abnormalities were noted.Comparative evaluations can be conducted to objectify improvement and tomaintain goal orientation.

Neurobiofeedback evaluations can be conduced for central nervous systemabnormalities.

TerraHertz wave (“T-wave”) imaging can be used to visualize softtissues, and may be especially useful for diagnosing disorders ofconnective tissues.

Digital photography can be conducted in cases of skin lesions includingvascular insufficiency or other clearly observable conditions. A linear,standardized color scale can be placed on the skin, to quantify theregion of observation. Date and time information can be recorded andcomparative evaluations can be conducted serially and recorded forfuture comparisons. In situations in which electromagnetic radiationtherapy is being used, frequent images can be recorded to provide easycomparisons during the course of therapy.

Postural evaluations can include scoliometers, pelvic asymmetrymeasurements, leg length measurements and the like can be used forpatients whose therapeutic goals are directed at those sites.

Circumferential measurements can be performed on extremities insituations in which edema or swelling or atrophy is a component of thepresenting symptoms and findings. Measurements can be taken at majorjoints and then more proximally or distally, or both. Measurements canalso be taken on the contralateral side for baseline and'; orcomparative reasons, and responses to treatment.

Broadband radar can be used to monitor rigidity of internal muscles,such as deep muscles of the leg.

Computers can be advantageously used to store, recall and compareinformation on a patient's progress. For example, computerizedalgorimetry can establish a patient's response to compression on thesymptomatic as well as asymptomatic sides for conditions that presentlaterally on the body. Stored data can be recalled and compared withcurrently obtained data. Histograms comparing variables can be producedto make comparisons easy. Computerized monofilament testing can be usedto quantify sensory perception threshold to light touch of a patient.

Skin pH measurements can be made, and can reflect normalization offunction of cellular function.

The above methods and devices are included by way of example only. Othertypes of measurements can be advantageously used with the methods ofthis invention to improve diagnosis and to follow the progress oftreatment.

The foregoing descriptions are provided by way of example only. Othersimilar methods can be used to treat other conditions having relatedphysiological characteristics. Workers of ordinary skill in the art canreadily appreciate that variations of the methods described herein areconsidered to be part of this invention.

Industrial Applicability

This invention provides methods for treating a variety of disordersusing electromagnetic radiation directed at excitable tissues, includingnerves, muscles and blood vessels. The electromagnetic radiation therapycan be used in conjunction with other forms of symptomatic therapy,including allopathic remedies, chiropracetic and other forms oftreatment known in the medical and health care arts.

1. A method for treating neuronal pain in a subject comprising the stepof: exposing a first site of an affected tissue associated with saidpain to localized electromagnetic radiation only within a wavelengthrange of about 400 to about 700 nm, a bandwidth only within thewavelength range, and a controlled variable selected from the groupconsisting of: (i) the bandwidth; and (ii) a wavelength variation overtime (“VOT”); said treating resulting in a decrease in said neuronalpain.
 2. The method of claim 1, said neuronal pain is associated with adisorder selected from the group consisting of carpal tunnel syndrome,peripheral neuropathy, tarsal tunnel syndrome, dental pain, gingivitis,and traumatic injury.
 3. The method of claim 1, further comprisingexposing a contralateral site associated with said pain to localizedelectromagnetic radiation.
 4. The method of claim 1, further comprisingexposing said subject to electromagnetic radiation at a site proximal tosaid first site.
 5. The method of claim 1, further comprising exposing asite near C1 to localized electromagnetic radiation.
 6. A method forreducing pain due to a neuronomuscular abnormality in a subject,comprising the step of: exposing a portion of a nerve or muscleassociated with said pain to a beam of localized electromagneticradiation only within a wavelength range of about 400 nm to about 700nm, a bandwidth only within the wavelength range, and a controlledvariable selected from the group consisting of: (i) the bandwidth; and(ii) a wavelength variation over time; said treating resulting in adecrease in said pain.
 7. The method of claim 6, said neuromuscularabnormality is a headache and the exposing step includes exposing aportion of the occipital nerve to a beam of electromagnetic radiation.8. The method of claim 7, said portion of the occipital nerve beingexposed to the beam of electromagnetic radiation at an angle of about45° to the cephalad.
 9. The method of claim 7, further comprisingexposing said subject to a beam of electromagnetic radiation at a sitenear the inner canthus of the eye.
 10. The method of claim 7, thewavelength range of the electromagnetic radiation being about 577 nm toabout 597 nm.
 11. The method of claim 7, the wavelength range of theelectromagnetic radiation being about 577 nm to about 622 nm.
 12. Themethod of claim 6, said neuromuscular abnormality beingtemporomandibular joint syndrome.
 13. The method of claim 12, saidwavelength range of the electromagnetic radiation being about 577 nm toabout 622 nm.
 14. The method of claim 12, said wavelength range beingabout 455 nm to about 492 nm.
 15. The method of claim 6, saidneuromuscular abnormality being trigeminal neuralgia.
 16. The method ofclaim 15, said nerve being the trigeminal nerve.
 17. A method fortreating a symptom associated with an abnormality of vascular perfusion,comprising the step of: exposing a portion of a tissue associated withsaid abnormality of vascular perfusion to an effective amount of alocalized electromagnetic radiation only within the visible wavelengthrange with a bandwidth only within the visible wavelength range and acontrolled variable selected from the group consisting of: (i) thebandwidth; and (ii) a wavelength variation over time; said treatingresulting in a decrease in said symptom.
 18. The method of claim 17,said abnormality of vascular perfusion being associated with a disorderselected from the group consisting of complex regional pain syndrome,sympathetic dystonia, reflex sympathetic dystrophy, sympathetichyperactivity, Reynaud's syndrome, muscle spasm, and peripheralneuropathy.
 19. The method of claim 17, said tissue being a blood vesselselected from the group consisting of the abdominal aorta, a femoralartery, a brachial artery, and the popliteal artery.
 20. The method ofclaim 17, said tissue being a nerve associated with said abnormality ofvascular permeability.
 21. The method of claim 1, said first site is oneof an electrodiagnostic point, an acupuncture point, a trigger point, ameridian, and an area along a nerve distribution to said tissue.
 22. Themethod of claim 1, said wavelength range of the electromagneticradiation including a central wavelength and said VOT changes by apredetermined wavelength variation around said central wavelength. 23.The method of claim 1, said wavelength VOT being in the range of about 1nm to about 100 nm.
 24. The method of claim 1, said wavelength VOToccurring with a cycle time in the range of about 1 sec to about 100sec.
 25. The method of claim 6, said exposing step including moving saidbeam of electromagnetic radiation between two locations of said nerve ormuscle.